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Accuracy of the nasal-tragus length measurement for correct endotracheal tube placement in a cohort of neonatal resuscitation simulators

Journal of Perinatology volume 37, pages 975–978 (2017)Cite this article

Subjects

Abstract

Objective:

Nasal-tragus length (NTL) estimates of endotracheal tube (ETT) depth are replacing weight-based estimates for endotracheal tube depth in neonates requiring endotracheal intubation. Existing neonatal simulators were designed before interest in using the NTL, and may lack fidelity in this measurement. The objective of this study is to evaluate the accuracy of the adjusted NTL formula and the Neonatal Resuscitation Program (NRP) gestational age/weight-based ETT depth chart in predicting proper endotracheal tube insertion depth in a cohort of neonatal simulators.

Study design:

The NTL and appropriate intubation depth to the mid-trachea were measured for 11 commonly used neonatal intubation simulators.

Results:

The NTL+1 cm formula incorrectly estimates the mid-tracheal depth in 82% of simulators, and the weight-based chart incorrectly estimates depth in 75% of test simulators. Only one simulator experienced a mainstem intubation with ETT insertion to the depth predicted by the NTL+1 cm formula.

Conclusions:

The majority of neonatal resuscitation simulations lacked physical fidelity with regard to mid-tracheal ETT insertion depth. The NRP gestational age/weight-based chart outperformed the NTL+1 cm formula but still resulted in endotracheal tube misplacement in the majority of neonatal simulators. The majority of simulators had adequate functional fidelity using either method for ETT depth estimation.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Neonatal Education and Simulation-Based Training (NEST) Program, University of Washington School of Medicine and Seattle Children’s Hospital, Seattle, WA, USA

    M M Gray, R Umoren, T P Strandjord & T Sawyer

  2. Division of Neonatology, Department of Pediatrics, Brooke Army Medical Center Simulation Center, San Antonio Military Medical Center, San Antonio, TX, USA

    H Delaney

Authors
  1. M M Gray
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  2. H Delaney
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  3. R Umoren
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  4. T P Strandjord
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  5. T Sawyer
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Correspondence to M M Gray.

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Gray, M., Delaney, H., Umoren, R. et al. Accuracy of the nasal-tragus length measurement for correct endotracheal tube placement in a cohort of neonatal resuscitation simulators. J Perinatol 37, 975–978 (2017). https://doi.org/10.1038/jp.2017.63

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