Chung Hao-Wei, Lee Wei-Te, Chen Hsiu-Lin
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Pediatr Neonatol. 2018 Jun;59(3):258-262. doi: 10.1016/j.pedneo.2017.10.001. Epub 2017 Oct 6.
The appropriate endotracheal tube (ET) depth for the newborn with respiratory failure is important. Inappropriate ET depth increases the risk of uneven lung expansion and collapse. This retrospective study aimed to compare the final ideal ET depth with Tochen's formula in Taiwanese intubated neonates, and to determine the correlation between neonatal factors and final ideal ET depth, and to devise an accurate predictive formula for use in Taiwan.
Data were collected from neonates who required endotracheal intubation and who were admitted to the Neonatal Intensive Care Unit from 2011 to 2015. Correlations between the final ideal ET depth, GA, and BW were assessed using the Pearson correlation test. Multiple regression analysis was used to produce a formula to predict appropriate ET depth from mouth angle to midtracheal position of neonates.
A total of 139 neonates were enrolled in this study. The final ideal ET depth was in concordance with Tochen's formula only in 19 neonates (13.7%); relatively deeper in 30 (21.6%) neonates; and shallower than the values from Tochen's formula in 90 (64.7%) neonates. Multiple regression analysis showed that the BW and GA together produced best prediction for final ideal ET depth in our study population. SGA and gender were shown to be insignificantly related to final ideal ET depth.
Our study showed the final ideal ET depth was shallower than Tochen's formula in 64.7% of neonates. Tochen's formula might not be suitable to predict ET depth for neonates in Taiwan. In our study, the new formula: 4.0 + 1.0 BW (kg) + 0.05 GA (weeks) provides a more accurate value and alternative method for evaluating the final ideal ET depth in Taiwan. A practical guideline for Asian neonates should be validated by prospective studies with large sample sizes.
对于呼吸衰竭的新生儿，合适的气管内插管（ET）深度很重要。ET深度不合适会增加肺扩张不均和肺萎陷的风险。这项回顾性研究旨在比较台湾接受插管的新生儿的最终理想ET深度与托臣公式，并确定新生儿因素与最终理想ET深度之间的相关性，以及设计一个适用于台湾的准确预测公式。
收集2011年至2015年入住新生儿重症监护病房且需要气管内插管的新生儿的数据。使用Pearson相关检验评估最终理想ET深度、胎龄（GA）和出生体重（BW）之间的相关性。采用多元回归分析得出一个公式，用于预测新生儿从口角到气管中部位置的合适ET深度。
本研究共纳入139例新生儿。最终理想ET深度仅与19例（13.7%）新生儿的托臣公式一致；30例（21.6%）新生儿相对更深；90例（64.7%）新生儿比托臣公式的值更浅。多元回归分析表明，在我们的研究人群中，BW和GA共同对最终理想ET深度产生了最佳预测。小于胎龄儿（SGA）和性别与最终理想ET深度的相关性不显著。
我们的研究表明，64.7%的新生儿最终理想ET深度比托臣公式更浅。托臣公式可能不适用于预测台湾新生儿的ET深度。在我们的研究中，新公式：4.0 + 1.0×BW（kg）+ 0.05×GA（周）为评估台湾新生儿的最终理想ET深度提供了更准确的值和替代方法。亚洲新生儿的实用指南应通过大样本前瞻性研究进行验证。
