Abstract
Objective To evaluate the association between endotracheal tube (ETT) tip position and adverse
pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants in whom ETT
insertion length was estimated using weight + 6 guide (adding 6 cms to the infant’s
weight in kg).
Study Design CXRs of 85 infants performed in the first week were reviewed for right-sided atelectasis,
air leaks, and uneven lung inflation. The first CXR was later reviewed to document
the ETT tip. Regression analysis was performed to find the association between ETT
tip position and adverse outcome after adjusting for other confounders.
Results Forty (46%) infants had ETT tip placement between the first and second thoracic vertebrae
(optimal position) compared with 45 (53%) who had the ETT tip placement outside this
range (suboptimal position). Infants with suboptimal ETT were ventilated for a longer
period (6.1 vs. 15.9 days; p = 0.004). The odds of adverse outcomes was 11.6 (95% confidence interval: 3.03, 44.1)
times higher among infants who did not have ETT at the optimal position compared with
infants who had ETT at the optimal position.
Conclusion Weight + 6 guide is not recommended to estimate ETT insertion length in extremely
preterm infants. Gestation-based guide may be more appropriate to estimate ETT insertion
length in this group of infants.
Keywords
endotracheal tube - extremely preterm infants - pulmonary outcomes - chest X-ray
