NEONATAL RESUSCITATION INTUBATION

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.