Research Article

Is It Time to Review Guidelines for ETT Positioning in the NICU? SCEPTIC—Survey of Challenges Encountered in Placement of Endotracheal Tubes in Canadian NICUs

Table 4

Preferred practices.

Oral intubation Unit (45%) transport (59%)

Premedication for elective/planned intubation Always or almost always (combined 93%)

Methods to secure ETTs (i) Tapes only (40%)
(ii) Tape plus adhesive (i.e., tapes used with addition of adhesive like Mastisol to increase the adhesive strength) (38%)
(iii) Sutures with tapes (11%)
(iv) Adhesives with tapes and sutures (2%)

Other methods used for securing ETT NeoBar, tapes with NeoBar, and NeoBridge

Point of measurement for an oral ETT Upper lip (70%)

Confirming the ETT position (i) 69% use 1 view (AP view)
(ii) 77% also rely on auscultation of the breath sounds
(iii) 19% also used other methods like end tidal co2 detectors, mist in the tube, chest rise, and clinical improvement

Reintubations (length same as before)94% would not get an X-ray

Position of the head during the CXRNeutral or midline (62%)

Analgesia/sedation during mechanical ventilationSometimes (66%)

Accidental extubations were reported Occasionally by 76%

Knowledge about the level of the vocal cords and carina Marked differences

Effects of flexion and extension on the ETT positionMarked differences

Auscultation of the bilateral breath sounds was not believed to rule out endobronchial intubations 70% agreed

Tube repositioning(i) 81% felt the need to reposition the ETT sometimes
(ii) T1-T2 26% will reposition
(iii) T2-T3 7% did not reposition