Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia

Allison C Young; Joseph L Hagan; Shweta S Parmekar; Pamela M Ketwaroo; Nathan C Sundgren

doi:10.1055/a-2370-2035

Comparison of Clinical Endotracheal Tube Depths with Standard Estimates for the Stabilization of Infants with Congenital Diaphragmatic Hernia

Am J Perinatol. 2024 Aug 13. doi: 10.1055/a-2370-2035. Online ahead of print.

Authors

Allison C Young¹, Joseph L Hagan², Shweta S Parmekar², Pamela M Ketwaroo³, Nathan C Sundgren²

Affiliations

¹ Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
² Division of Neonatology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.
³ Department of Radiology, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas.

PMID: 39038792
DOI: 10.1055/a-2370-2035

Abstract

Objective: This study aimed to compare the clinical endotracheal tube (ETT) depth after initial stabilization of infants with congenital diaphragmatic hernia (CDH) to weight and gestational age-based depth estimates.

Study design: This retrospective analysis included 58 inborn infants with left-sided CDH. We compared a standard anatomic ETT depth calculated from initial chest radiographs and the clinical depth of the ETT after adjustments to predicted depths using weight and gestational age-based estimates.

Results: The standard anatomic depth was deeper than age (standard deviation 1.29 ± 1.15 cm, p < 0.001) and weight-based (standard deviation 0.59 ± 0.95 cm, p < 0.001) estimates. The clinical ETT depth was also deeper than age (standard deviation 1.01 ± 0.77 cm, p < 0.001) and weight-based (standard deviation 0.26 ± 0.50 cm, p < 0.001) estimates.

Conclusion: Established strategies to predict ETT depth underestimate the ideal depth in infants with left-sided CDH. These data suggest utilizing caution during initial ETT placement based on standard depth estimates for patients with CDH.

Key points: · CDH patients present unique stabilization challenges.. · Standard ETT depth estimates are too shallow.. · Resuscitation teams should cautiously choose ETT depth..