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    Patent Pending

    Endotracheal Tube (ETT) Depth and Tidal Volume Calculator

    Estimates depth of optimal ETT placement and target tidal volume by height.
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    INSTRUCTIONS

    Use in patients over 20 years old.

    When to Use
    Pearls/Pitfalls
    Why Use

    Adult patients requiring orotracheal intubation.

    • ETT depth is measured based on the patient’s front teeth (not the molars).
    • Larger tidal volumes may be temporarily required for patients with severe metabolic acidosis.
    • Placing the ETT too deeply may cause right mainstem intubation, hypoxemia, and pneumothorax. However, placing the ETT too shallowly may risk injury to the vocal cords and accidental extubation. Standard approaches to verify ETT depth (e.g. bilateral auscultation) are insensitive.
    • Use of lower tidal volumes appears to prevent the development of acute respiratory distress syndrome, even in patients who do not have lung injury.
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    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • ETT position should still be verified with a chest radiograph among patients who will remain intubated for an extended period of time.
    • Tidal volume: 6-8 mL/kg ideal body weight (IBW) is generally a safe initial setting, but further ventilator adjustment may be required depending on the adequacy of ventilation and airway pressures.

    Management

    Endotracheal intubation and mechanical ventilation.

    Critical Actions

    Chest radiograph and measurement of CO2 level (e.g. end-tidal CO2 or blood gas analysis) to confirm ETT position and adequacy of ventilation.

    Content Contributors
    • Joshua Farkas, MD
    About the Creator
    Dr. Anchalee Techanivate
    Are you Dr. Anchalee Techanivate?
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    Content Contributors
    • Joshua Farkas, MD