Comparison between the Oro-Helical Length Technique And the 7-8-9 Rule in Determination of the Ideal Endotracheal Tube Insertion Depth in Neonates

Abstract

Background: Neonatal tracheal intubation (TI) is a life-saving but potentially dangerous procedure. Insufficient ventilation, pneumothorax, laryngeal trauma, atelectasis or even death can result from ETT malposition. Aim: To evaluate the oro-helical method as an alternative to the 7-8-9 rule method in determination of the ideal endotracheal tube (ETT) insertion depth in neonates. Patients and Methods: This study comprised 120 neonates; 60 neonates were intubated according to the OHL method and the other 60 neonates were intubated according to the 7-8-9 rule method. The depth of ETT insertion in infants who were intubated at Neonatal Care Unit was determined either by the oro-helical method or the 7-8-9 rule method. Full history taking, clinical examination including anthropometric measures, vital data and local examination and radiological investigations using X-rays were done after intubation. Results: There was no difference between neonates in the OHL method group and the rule 7-8-9 group regarding the age at intubation, birth weight, sex, maturity, as well as, IUGR, the gestational age (ranging from 28 to 39 weeks) with mean gestational age of 36 weeks in both study groups. There was no difference between both groups regarding attempts of intubations and mode of ventilation with (P value > 0.05). There was no significant difference between both groups regarding the incidence of pneumothorax. Both groups were comparable regarding occurrence of underinflation and overinflation (P value > 0.05). Conclusion: The oro-helical length method is a safe alternative to the 7 8-9 method in estimation of the endotracheal insertion depth, especially if the weight was unknown in emergency situations. This is with an acceptable accuracy and without increasing the incidence of air leaks or accidental extubation.