A Rapid and Reliable Method of Selecting Endotracheal Tube Size in Children.

Hinkle AJ Anesthesia and Analgesia 1988 Page 592 Abstract

Noting that selection of appropriately sized endotracheal tubes for airway management in pediatric patients is a critical procedure, this study is both retrospective and prospective. The retrospective aspect was to determine which anthropometric measurement in children (body weight, age, body length, neck circumference, fifth fingernail width, fifth finger distal interphalangeal joint circumference or nostril diameter) was the best predictor of appropriate ETT size. 200 children (birth-12 years) were intubated and had the above anthropometric data recorded. Correlation coefficients were calculated between correct ETT size and all seven parameters. Body length had the best correlation coefficient (r) of 0.95. The r values of the other parameters were all <.90. The prospective study was then used to verify the accuracy of the "best" predictor (body length) identified in the retrospective study. 200 children (birth-12 years) were intubated with an ETT size based on body length. A tape measure was designed that could be held against each child and the appropriate ETT size read off. Correct ETT size was predicted in 100% of the patients on first attempt. The author concludes that body length is superior to any other anthropometric measurement or formulae in allowing rapid and reliable selection of correct ETT size for children.