Paediatric Acute care Guidelines PMH Emergency Department

General

  • Endotracheal tubes (ETT) are used to intubate patients

Equipment

Cuffed versus Uncuffed ETT:

  • Cuffed ETT are the preferred choice in the Emergency Deaprtment in all children except neonates
  • The cuff may or may not be inflated (depending on the clinical situation)
  • The aim is to have a tight fit with a small gas leak – to prevent oedema at extubation due to mucosal damage around the cricoid (narrowest part of the airway in a child)

ETT Sizing:

  • Preterm neonate: size 2.5
  • Neonate: size 3.0 – 3.5
  • Infant < 1 yr: size 3.5 – 4.0
  • Cuffed ETT in children < 2 yrs = size 3
  • Formula for cuffed ETT (> 2 yr) = (age/4) + 3.5
  • Formula for uncuffed ETT (> 1yr) = (age/4) + 4
Formula For ETT Length (in cm):
 
  • Measure at the lips with the head in neutral position
  • Neonate: 9.5cm
  • 1 yr: 12cm
  • Formula for oral tube (>1 yr) = age/2 + 12
  • Formula for nasal tube = (< 1 yr) age/2 + 15 

Additional Equipment:

  • Always have the estimated size ETT as well as a half size smaller and a half size larger prepared
  • An introducer can be placed inside the ETT to allow more control when inserting the tube
  • It must never stick out the end of the ETT (or it may damage the airway mucosa)
  • Lubricate the end of the ETT before intubation

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