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Evaluating the Practice of Repositioning Endotracheal Tubes in Neonates and Children Based on Radiographic Location*

Im, Daniel D. MD1,2,3; Ross, Patrick A. MD1,2; Hotz, Justin RRT-NPS4; Newth, Christopher J. L. MD, FRCPC1,2

Pediatric Critical Care Medicine: November 2019 - Volume 20 - Issue 11 - p 1057-1060
doi: 10.1097/PCC.0000000000002053
Neonatal Intensive Care

Objectives: Chest radiographs are commonly performed in the ICU setting to confirm the position of the endotracheal tube. The purpose of this study was to evaluate the practice and accuracy of repositioning endotracheal tubes in the pediatric population based on chest radiograph.

Design: Retrospective review of patient’s medical record and chest radiograph.

Setting: Single-institution, academic children’s hospital.

Patients: PICU and cardiothoracic ICU patients who had repositioning of their endotracheal tube from September 1, 2016, to September 1, 2017.

Measurements and Main Results: Chest radiograph before and after endotracheal tube repositioning were examined measuring the distance from the endotracheal tube tip to carina. A total of 183 endotracheal tube repositionings were assessed. Twenty-nine percent of endotracheal tube repositionings resulted in a persistently malpositioned endotracheal tube, requiring another intervention. For intended endotracheal tube repositioning of ± 2.0 cm, the actual change measured compared to intended adjustment was a median of 0.7 cm (interquartile range, 0.35–1.1 cm). For intended ± 1.5 cm, the median difference was 0.4 cm (interquartile range, 0.16–0.90 cm). For intended ± 1.0 cm, the median difference was 0.5 cm (interquartile range, 0.20–0.90 cm). For intended ± 0.5 cm, the median difference was 0.3 cm (interquartile range, 0.2–0.88 cm). When the head was malpositioned the difference from intended endotracheal tube repositioning to actual was median 0.70 cm (interquartile range, 0.40–1.1 cm), this was significantly higher than when the head was in a good position

Conclusions: When repositioning endotracheal tubes based on chest radiograph, there is a significant difference between intended and actual adjustment with great variability. Avoiding very small repositionings (± 0.5 cm) and standardizing head position prior to daily chest radiograph may reduce these errors.

1Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, CA.

2Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA.

3Department of Pediatrics, LAC+USC Medical Center, Los Angeles, CA.

4Department of Respiratory Care, Children’s Hospital Los Angeles, CA.

*See also p. 1095.

Dr. Newth received funding from Philips Research North America. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies