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It was good to read Gill et al’s1 report on a carefully conducted randomised trial examining methods to estimate endotracheal tube (ETT) length. Together with their group’s previous trial,2 neither use of the vocal cord guide nor a gestation-based formula showed superiority over the traditional 7-8-9 rule (Tochen’s formula).
In this recent study, under half the infants had their ETT tip in the target radiographic position, despite being intubated in the neonatal unit, rather than immediately after birth. This success rate might reflect the methods used and also indicate that ETT intubation is a complex system requiring many elements to modify practice.
They noted that staff often secured the ETT lower than recommended. The tendency to push the tube in by an extra …
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