A novel measurement point for determining the optimal endotracheal tube tip depth in neonates: The gum

INTRODUCTION: Improper placement of an endotracheal tube can result in numerous severe complications. Several techniques have been suggested to determine the correct positioning of orotracheal intubation in neonates. Our objective was to evaluate measurements obtained at both the lip and gingival levels, with the aim of identifying an alternative approach for determining the optimal depth of the endotracheal tube.
METHODS: This prospective observational study was conducted between December 2022 and September 2023. The depth of the endotracheal tube was evaluated by a single investigator, and a chest X-ray (CXR) was performed afterwards. Immediately before the CXR, the investigator marked the tube both at the levels of the anterior superior gingival margin and the upper lip margin on the midline. The position of the endotracheal tube tip, as assessed in the CXR, was compared to measurements taken from the anterior superior gingival and upper lip margin levels. Since the main problem with most formulas for appropriate endotracheal tube positioning is faced when the babies are very small, we divided the group into very low birth weight infants and the others.
RESULTS: During the study period, 59 intubated patients had a scheduled CXR during working hours, resulting in a total of 94 measurements from 26 females (44%) and 33 males (56%). Endotracheal tube tip–lip, endotracheal tube tip–gingiva, and nasal tragus distances were classified according to whether the endotracheal tube was within the target range or positioned deep or high according to the CXR. It was determined that there was statistically high agreement among all measurements. Formulas were developed for the targeted lip and gum measurements for achieving the optimal endotracheal tube position, and the results were found to be statistically significant.
DISCUSSION AND CONCLUSION: The formulas established in this study provide a swift and precise method for determining the insertion depths of the endotracheal tube tip at the gingival level in neonates.