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NEONATAL RESUSCITATION INTUBATION
Category: Child Health
Abstract : neonatal resuscitation - Intubation Infants may require tracheal intubation
if direct tracheal suctioning is required, effective bag-mask ventilation cannot
be provided, congenital diaphragmatic hernia is suspected, or a prolonged need
for assisted ventilation exists. An appropriate blade (Miller size 0-1) should
be chosen depending on the size of the infant. Premature infants may be mo
neonatal resuscitation - Intubation
Infants may require tracheal intubation
if direct tracheal suctioning is required, effective bag-mask ventilation cannot
be provided, congenital diaphragmatic hernia is suspected, or a prolonged need
for assisted ventilation exists. An appropriate blade (Miller size 0-1) should
be chosen depending on the size of the infant.
Premature infants may be more
easily intubated with a size 0 blade, and term infants require a size 1 blade.
An appropriate size of endotracheal tube (ETT) should be chosen based on the
weight of the infant.
Upon insertion of the ETT, the tube should be
advanced until the vocal cord guide mark near the distal tip of the tube is
visualized to be slightly past the vocal cords. This guide mark is positioned a
variable distance from the distal tip (depending on the ETT size) and is
designed to result in the placement of the tube tip between the vocal cords and
the carina at the bifurcation of the right and left mainstem bronchi. The ETT
should then be secured and cut to an appropriate length to minimize dead space
and flow resistance.
Another estimate of correct placement of the ETT is
to use the weight of the infant in kilograms plus 6 to arrive at the number of
centimeters at which the tube should be secured at the lip. Before securing the
ETT, the infant should be assessed for equal bilateral breath sounds with
maintenance of oxygenation.
ETT position is confirmed with a chest x-ray.
Free flow oxygen should be provided throughout the procedure, and then effective
ventilation via the bag or ventilator after the infant is intub.
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