Doctor’s blog on how to position an ET tube in a micropreemie. Complicated and technical, but important. Our micropreemie (now 2) has a partially paralyzed vocal cord, and we think it’s because of a rough intubation.

Neonatal Research

Our tiny babies have very tiny tracheas. So far you are probably all with me. Putting that tube in the right position is therefore tricky. In particular avoiding the right mainstem bronchus, which is the wrong position, is important.

So first of all; where should the tip be? That seems obvious, it should be in the trachea, high enough above the carina that the tube never slips into the carina, but low enough that it doesn’t slip out. On a plain AP radiograph, however, it isn’t always clear exactly where the tube tip should be. In general ,studies have suggested that on the radiograph the tip of the tube should be T1-T2. That is based on studies where the position was directly observed, such as in post-mortem studies, and compared with an X-ray.

A study from 7 years ago (Thayyil S, et al: Optimal endotracheal tube tip position in extremely…

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