Children Tracheal intubation

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a premature infant weighing 990 grams (35 ounces), intubated , requiring mechanical ventilation in neonatal intensive-care unit


there significant differences in airway anatomy , respiratory physiology between children , adults, , these taken careful consideration before performing tracheal intubation of pediatric patient. differences, quite significant in infants, gradually disappear human body approaches mature age , body mass index.


for infants , young children, orotracheal intubation easier nasotracheal route. nasotracheal intubation carries risk of dislodgement of adenoids , nasal bleeding. despite greater difficulty, nasotracheal intubation route preferable orotracheal intubation in children undergoing intensive care , requiring prolonged intubation because route allows more secure fixation of tube. adults, there number of devices specially designed assistance difficult tracheal intubation in children. confirmation of proper position of tracheal tube accomplished adult patients.


because airway of child narrow, small amount of glottic or tracheal swelling can produce critical obstruction. inserting tube large relative diameter of trachea can cause swelling. conversely, inserting tube small can result in inability achieve effective positive pressure ventilation due retrograde escape of gas through glottis , out mouth , nose (often referred leak around tube). excessive leak can corrected inserting larger tube or cuffed tube.


the tip of correctly positioned tracheal tube in mid-trachea, between collarbones on anteroposterior chest radiograph. correct diameter of tube results in small leak @ pressure of 25 cm (10 in) of water. appropriate inner diameter endotracheal tube estimated same diameter child s little finger. appropriate length endotracheal tube can estimated doubling distance corner of child s mouth ear canal. premature infants 2.5 mm (0.1 in) internal diameter appropriate size tracheal tube. infants of normal gestational age, 3 mm (0.12 in) internal diameter appropriate size. nourished children 1 year of age , older, 2 formulae used estimate appropriate diameter , depth tracheal intubation. internal diameter of tube in mm (patient s age in years + 16) / 4, while appropriate depth of insertion cm 12 + (patient s age in years / 2).








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