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Original Article
Does the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray?
- Dayanna Letícia Silva Santos
, - Paulo Douglas de Oliveira Andrade,
- Evelim Leal de Freitas Dantas Gomes
Abstract
Original ArticleDoes the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray?
Rev Bras Ter Intensiva. 2020;32(2):295-300
DOI 10.5935/0103-507X.20200046
- Dayanna Letícia Silva Santos ,
- Paulo Douglas de Oliveira Andrade,
- Evelim Leal de Freitas Dantas Gomes
Views0ABSTRACT
Objective:
To evaluate the effectiveness of the different formulas for estimating the insertion depth of an endotracheal tube in children.
Methods:
This was an observational and cross-sectional study that included children between 29 days and 2 years of age who were hospitalized in a pediatric intensive care unit and mechanically ventilated. The formulas based on height [(height/10) + 5], the inner diameter of the tube (endotracheal tube × 3), and weight (weight + 6) were evaluated to determine which of them showed better concordance with the ideal insertion depth of the endotracheal tube as evaluated by X-ray.
Results:
The correlation between the height-based calculation and the ideal depth observed on X-ray was strong, with r = 0.88, p < 0.05, and a concordance correlation coefficient of 0.88; the correlation between the weight-based calculation and depth on X-ray was r = 0.75, p < 0.05, and concordance correlation coefficient 0.43; and the correlation between endotracheal tube diameter-based calculation and depth on X-ray was r = 0.80, p < 0.05, and concordance correlation coefficient 0.78. Lin’s concordance correlation analysis indicated that the measurements showed weak concordance (< 0.90).
Conclusion:
The formulas that estimate the insertion depth of the endotracheal tube in children were not accurate and were discordant with the gold-standard method of X-ray evaluation. There is a need for a new method based on anthropometric variables (weight and height) and age that is effective in guiding health professionals of pediatric intensive care units at the time of intubation.
Keywords:ChildInfantIntensive care units, pediatricIntubation, intratrachealThorax/imaging diagnosisSee moreViews0
Abstract
Original ArticleDoes the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray?
Rev Bras Ter Intensiva. 2020;32(2):295-300
DOI 10.5935/0103-507X.20200046
- Dayanna Letícia Silva Santos ,
- Paulo Douglas de Oliveira Andrade,
- Evelim Leal de Freitas Dantas Gomes
Views0ABSTRACT
Objective:
To evaluate the effectiveness of the different formulas for estimating the insertion depth of an endotracheal tube in children.
Methods:
This was an observational and cross-sectional study that included children between 29 days and 2 years of age who were hospitalized in a pediatric intensive care unit and mechanically ventilated. The formulas based on height [(height/10) + 5], the inner diameter of the tube (endotracheal tube × 3), and weight (weight + 6) were evaluated to determine which of them showed better concordance with the ideal insertion depth of the endotracheal tube as evaluated by X-ray.
Results:
The correlation between the height-based calculation and the ideal depth observed on X-ray was strong, with r = 0.88, p < 0.05, and a concordance correlation coefficient of 0.88; the correlation between the weight-based calculation and depth on X-ray was r = 0.75, p < 0.05, and concordance correlation coefficient 0.43; and the correlation between endotracheal tube diameter-based calculation and depth on X-ray was r = 0.80, p < 0.05, and concordance correlation coefficient 0.78. Lin’s concordance correlation analysis indicated that the measurements showed weak concordance (< 0.90).
Conclusion:
The formulas that estimate the insertion depth of the endotracheal tube in children were not accurate and were discordant with the gold-standard method of X-ray evaluation. There is a need for a new method based on anthropometric variables (weight and height) and age that is effective in guiding health professionals of pediatric intensive care units at the time of intubation.
Keywords:ChildInfantIntensive care units, pediatricIntubation, intratrachealThorax/imaging diagnosisSee more
- Dayanna Letícia Silva Santos
-
Original Articles
Autonomic responses of premature newborns to body position and environmental noise in the neonatal intensive care unit
- Evelim Leal de Freitas Dantas Gomes ,
- Camilla Malta dos Santos,
- Anelise da Costa Souza Santos,
- Aline Gomes da Silva,
- Mariza Aparecida Malaquias França, [ … ],
- Dirceu Costa
Abstract
Original ArticlesAutonomic responses of premature newborns to body position and environmental noise in the neonatal intensive care unit
Rev Bras Ter Intensiva. 2019;31(3):296-302
DOI 10.5935/0103-507X.20190054
- Evelim Leal de Freitas Dantas Gomes ,
- Camilla Malta dos Santos,
- Anelise da Costa Souza Santos,
- Aline Gomes da Silva,
- Mariza Aparecida Malaquias França,
- Dyele Souza Romanini,
- Manoela Cristina Veiga de Mattos,
- Andrea Fernanda Leal,
- Dirceu Costa
Views0See moreABSTRACT
Objective:
Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit.
Methods:
A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone.
Results:
Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions.
Conclusion:
The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.
Views0Abstract
Original ArticlesAutonomic responses of premature newborns to body position and environmental noise in the neonatal intensive care unit
Rev Bras Ter Intensiva. 2019;31(3):296-302
DOI 10.5935/0103-507X.20190054
- Evelim Leal de Freitas Dantas Gomes ,
- Camilla Malta dos Santos,
- Anelise da Costa Souza Santos,
- Aline Gomes da Silva,
- Mariza Aparecida Malaquias França,
- Dyele Souza Romanini,
- Manoela Cristina Veiga de Mattos,
- Andrea Fernanda Leal,
- Dirceu Costa
Views0See moreABSTRACT
Objective:
Evaluate the physiological and autonomic nervous system responses of premature newborns to body position and noise in the neonatal intensive care unit.
Methods:
A quasi-experimental study. The autonomic nervous system of newborns was evaluated based on heart rate variability when the newborns were exposed to environmental noise and placed in different positions: supine without support, supine with manual restraint and prone.
Results:
Fifty premature newborns were evaluated (gestational age: 32.6 ± 2.3 weeks; weight: 1816 ± 493g; and Brazelton sleep/awake level: 3 to 4). A positive correlation was found between environmental noise and sympathetic activity (R = 0.27, p = 0.04). The mean environmental noise was 53 ± 14dB. The heart rate was higher in the supine position than in the manual restraint and prone positions (148.7 ± 21.6, 141.9 ± 16 and 144 ± 13, respectively) (p = 0.001). Sympathetic activity, represented by a low frequency index, was higher in the supine position (p < 0.05) than in the other positions, and parasympathetic activity (high frequency, root mean square of the sum of differences between normal adjacent mean R-R interval and percentage of adjacent iRR that differed by more than 50ms) was higher in the prone position (p < 0.05) than in the other positions. The complexity of the autonomic adjustments (approximate entropy and sample entropy) was lower in the supine position than in the other positions.
Conclusion:
The prone position and manual restraint position increased both parasympathetic activity and the complexity of autonomic adjustments in comparison to the supine position, even in the presence of higher environmental noise than the recommended level, which tends to increase sympathetic activity.
- Evelim Leal de Freitas Dantas Gomes
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Case reports Child Coronavirus infections COVID-19 Critical care Critical illness Extracorporeal membrane oxygenation Infant, newborn Intensive care Intensive care units Intensive care units, pediatric mechanical ventilation Mortality Physical therapy modalities Prognosis Respiration, artificial Respiratory insufficiency risk factors SARS-CoV-2 Sepsis