Recommendations for endotracheal tube insertion depths in children

Emerg Med J. 2023 Aug;40(8):583-587. doi: 10.1136/emermed-2022-212494. Epub 2023 Jun 19.


Background: Endotracheal tube (ETT) malposition is frequent in paediatric intubation. The current recommendations for ETT insertion depths are based on formulae that hold various limitations. This study aimed to develop age-based, weight-based and height-based curve charts and tables for ETT insertion depth recommendations in children.

Methods: In this retrospective single-centre study, we determined the individual optimal ETT insertion depths in paediatric patients by evaluating postintubation radiographic images. Age-based, weight-based and height-based ETT insertion depth recommendations were developed using regression analysis. We compared the insertion depths predicted by the models with previously published formulae.

Results: Intubations of 167 children (0-17.9 years) were analysed. Best-fit curves generated with logistic regression analysis revealed R2 values between 0.784 and 0.880. The insertion depths predicted by the models corresponded well with published age-based and height-based formulae. However, they demonstrated the unsuitability of weight-related linear formulae to predict ETT depth in children.

Conclusion: The recommendations developed in this study facilitate a fast and accurate determination of recommended ETT insertion depths in children. Our recommendations provide greater accuracy than previously published formulae and demonstrate that weight-related linear formulae are unsuitable for predicting ETT depth in children.

Keywords: Rapid Sequence Induction and Intubation; airway; clinical; critical care; pediatric emergency medicine.

MeSH terms

  • Child
  • Humans
  • Intubation, Intratracheal* / methods
  • Regression Analysis
  • Retrospective Studies