Pediatric Endotracheal Tube (ETT) Size
Estimates ET tube size based on age.
Advice
- The largest tube size should be used to facilitate easier suctioning and ventilation, but the endotracheal tube should never be forcefully inserted through the vocal cords.
- Video laryngoscopy improves first pass success and should be used when available.
- If an endotracheal tube cannot be placed, rescue with bag-mask ventilation or supraglottic airway placement is often successful.
Management
- Prior to intubation, ensure that extra tube sizes, airway adjuncts, supraglottic airways, and alternative laryngoscope blade sizes are available.
- Children have a shorter safe apneic time (i.e. desaturate more rapidly when apneic) as compared to adults; adequate preoxygenation (at any age) is critical to maximizing safe apneic time.
- Have post-intubation sedation readied as part of the pre-intubation preparation. Sedation/induction agents will often wear off before neuromuscular blockers do, which can lead to awareness under paralysis.
- Waveform end-tidal capnography is the most reliable way to verify successful intubation of the trachea, though this should always be done in conjunction with other methods (auscultation, X-ray, visualization of tube misting, direct or video visualization of the tube entering the glottic opening).
Critical Actions
- Cuffed tubes are almost always preferred.
- Consultation with a pediatric airway expert is recommended in cases of a predicted anatomically difficult airway (airway malformations, tumors).