Neonatal Unit, Aberdeen Maternity Hospital, Aberdeen, United Kingdom.
Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine, London, United Kingdom.
Am J Perinatol. 2019 Dec;36(14):1498-1503. doi: 10.1055/s-0039-1678531. Epub 2019 Feb 19.
To evaluate the association between endotracheal tube (ETT) tip position and adverse pulmonary outcomes using chest X-ray (CXR) in extremely preterm infants in whom ETT insertion length was estimated using weight + 6 guide (adding 6 cms to the infant's weight in kg).
CXRs of 85 infants performed in the first week were reviewed for right-sided atelectasis, air leaks, and uneven lung inflation. The first CXR was later reviewed to document the ETT tip. Regression analysis was performed to find the association between ETT tip position and adverse outcome after adjusting for other confounders.
Forty (46%) infants had ETT tip placement between the first and second thoracic vertebrae (optimal position) compared with 45 (53%) who had the ETT tip placement outside this range (suboptimal position). Infants with suboptimal ETT were ventilated for a longer period (6.1 vs. 15.9 days; = 0.004). The odds of adverse outcomes was 11.6 (95% confidence interval: 3.03, 44.1) times higher among infants who did not have ETT at the optimal position compared with infants who had ETT at the optimal position.
Weight + 6 guide is not recommended to estimate ETT insertion length in extremely preterm infants. Gestation-based guide may be more appropriate to estimate ETT insertion length in this group of infants.
通过胸部 X 光（CXR）评估使用体重+6 引导（在婴儿体重的公斤数上加 6 厘米）估计气管插管（ETT）插入长度的极早产儿中 ETT 尖端位置与不良肺部结局之间的关系。
对 85 名婴儿在第一周进行的 CXR 进行了右侧肺不张、气胸和不均匀肺充气的评估。然后对第一张 CXR 进行复查，以记录 ETT 尖端位置。回归分析用于在调整其他混杂因素后，发现 ETT 尖端位置与不良结局之间的关联。
40 名（46%）婴儿的 ETT 尖端位置在第一和第二胸椎之间（最佳位置），而 45 名（53%）婴儿的 ETT 尖端位置超出此范围（次优位置）。ETT 尖端位置不佳的婴儿通气时间更长（6.1 天 vs. 15.9 天；=0.004）。与 ETT 尖端位于最佳位置的婴儿相比，未处于最佳位置的婴儿不良结局的可能性高 11.6 倍（95%置信区间：3.03，44.1）。
不建议使用体重+6 引导来估计极早产儿的 ETT 插入长度。基于胎龄的引导可能更适合估计这组婴儿的 ETT 插入长度。
