Background Malpositioned endotracheal tubes (ETT) in ventilated neonates are associated with adverse pulmonary outcomes including unequal surfactant delivery, asymmetric lung expansion and air-leaks.¹ Use of gestation age (GA) based guideline to determine the ETT length at lips resulted in reduction of the need for ETT repositioning from 53% to 8%.² This guideline is recommended by ILCOR.³

Aim To assess adherence to guidelines and need for ETT repositioning.

Methods Ventilated neonates < 24 hours of age, transferred by a regional transfer service during study periods of January to March (3-months) in the years 2008 (pre-publication²) and 2011 (post-publication²) were included. Demographic data, ETT size, length at upper-lip, position on chest X-ray and need for repositioning were collected.

Results Similar proportion of ETT’s were repositioned during 2008 and 2011 (30% vs 37%, p=0.59). During both periods the proportion of ETT’s repositioned were significantly higher (p<0.05) with greater deviation of ET length insertion from the guideline:

Conclusion Adherence to guideline is associated with significant reduction in need for ETT repositioning. Publication of guideline has had limited effect. There is need for improving dissemination of evidence based guidelines to improve outcomes.

1. Thayyil et al. Am J Perinatol 2008.

2. Kempley et al. Resuscitation 2008.

3. Richmond et al. Resuscitation 2010.