Prospective assessment of guidelines for determining appropriate depth of endotracheal tube placement in children

Lorri M. Phipps, Neal J. Thomas, Raymond K. Gilmore, Jill A. Raymond, Toni R. Bittner, Richard A. Orr, Courtney L. Robertson

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Objective: To determine whether multiplying the internal diameter of the endotracheal tube (ETT) by 3 (3× ETT size) is a reliable method for determining correct depth of oral ETT placement in the pediatric population. Design: Prospective, observational. Setting: University-affiliated, 12-bed pediatric intensive care unit. Patients: Orally intubated pediatric intensive care unit patients of ≤12 yrs of age. Interventions: Demographics, ETT size, and depth of ETT placement measured from the lip were obtained. Correct placement, defined as the tip of the ETT below the thoracic inlet and ≥0.5 cm above the carina, was determined by chest radiograph. Measurements and Main Results: Suggested ETT size based on the Pediatric Advanced Life Support (PALS) age-based formula and the Broselow tape-length-based guidelines were determined. A total of 174 of 226 ETTs (77%) were correctly positioned. If practitioners utilized the 3× ETT size for the actual tubes chosen, 170 of 226 (75%) would have been accurately placed. More accurate were the 3× PALS-based ETT size (81%) and 3× Broselow-suggested ETT size (85%). The use of the Broselow ETTs to determine the depth would have led to a significantly improved ETT position (p = .003) compared with the actual ETT. Conclusion: The commonly used formula of 3× tube size for ETT depth in children results in 15-25% malpositioned tubes. Practitioners can improve the reliability of this formula by utilizing the recommended ETT size as suggested by the Brosolow tape. A more reliable method is necessary to avoid ETT malposition.

Original languageEnglish (US)
Pages (from-to)519-522
Number of pages4
JournalPediatric Critical Care Medicine
Issue number5
StatePublished - Sep 2005

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Critical Care and Intensive Care Medicine


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