The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts


KC Ong, GD A'Court, P Eng, YY Ong Department of Respiratory & Critical Care Medicine, Singapore General Hospital

Ideal position of the endotracheal tube (ETT) within the trachea is 5±2 cm from the carina with the head in neutral position (Goodman's criteria). Previous studies in Western populations have shown that it was possible to achieve ideal positioning of oral ETTs in nearly all patients by placing the ETT at the reference marks of 23cm in men and 21 cm in women. However, our previous study using these reference marks for our local population did not result in ideal positioning in a significant proportion of cases (32.3%).

We therefore conducted a prospective cohort study to assess the possibility of achieving ideal ETT position by placing ETTs at reference marks of 21 cm in men and 19cm in women.

All patients orally intubated in the Medical Intensive Care Unit, SGH between May-December 1995 had their ETTs positioned according to the new reference marks. Patients beyond normal height range (154-184cm-males; 144-171cm-females) were excluded.

Eighty men and 53 women were studied (n=133). The median distance of ETT tip to carina was 5.0 cm with a range of 2.0-10.0 cm. Ideal positioning were achieved in 107(80.5%). Nine (6.8%) had the ETT tip < 3cm from the carina and 17(12.8%)>7cm. The proportion with ideal ETT positions was significantly larger compared to our previous study (p=0.00005).

Adopting the new reference marks resulted in more cases with appropriate ETT positioning. Routine use of these reference marks as a guide for ETT placement in our Asian population may reduce complications associated with ETT malposition.

Reference: OF-96-064

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