7 Intubation: Equipment and Procedure
Laryngoscope Blade Selection:
Below is a chart with guidelines for selecting laryngocope blade and ETT size. IN general, it is recommended to use a straight blade from children under the age of 1 year, and to use a curved Mac blade thereafter. You can check that you have chosen the appropriate size by holding the blad up to the patients mandible. By holding the portion of the blade where hub and blade meet up to the patients angle of the mandible, the tip of the blade should reach the corner of the mouth plus/minus 1cm.
| Age |
Weight (Kg) |
Blade |
ETT |
| NB |
|
0-1 |
3 |
| Infant |
5 |
1 |
3.5 |
| Toddler |
10 |
1-2 or 1.5 Wis-Hipple |
4.5 |
| 6 years |
20 |
2 |
5 |
| 9 years |
30 |
2 |
6 |
| Adolescent |
50 |
3 |
7 |
| Adult |
>50 |
3 |
8 |
Endotracheal Tube size selection:
There are multiple calculations used to estimate an appropriately sized ETT. In the PICU it is rare to place an uncuffed tube as this can make oxygenation/ventilation difficult in children with a large air leak, poor lung compliance, or both. Of note, although these age based calculations have been found to be reliable, using a Broselow tape to measure the patients length and estimate ETT size has been found to be more reliable and can be used when you don’t know the patient’s age.
- Cuffed tube: (Age/4) + 3
- Uncuffed tube: (Age/4) + 4
Depth of ETT Insertion:
- Newborn: 6 + weight (kg)
- Others: 3 X size of ETT
Microcuff Pediatric ETT Size Selection:
| Tube Size ID |
Age (Yrs) |
| 3.5 |
8 mo to < 2yrs |
| 4 |
2 to < 4 yrs |
| 4.5 |
4 to < 6yrs |
| 5 |
6 to < 8yrs |
| 5.5 |
8 to <10 yrs |
| 6 |
10 to < 12 yrs |
| 6.5 |
12 to < 14 yrs |
| 7 |
14 to < 16 yrs |
Medications for Intubation:
| Cardiac Patients |
|
|
Notes |
| Atropine |
|
0.02 mg/kg/dose (1 cc, infants) |
|
| Fentanyl |
|
2.5-5 mcg/kg/dose |
|
| Rocuronium |
|
1 mg/kg/dose |
|
| High ICPs |
|
|
|
| Lidocaine |
|
1 mg/kg/dose |
- Anesthetizes pharynx to decrease pain and risk of increased ICP
|
| Etomidate |
|
0.1-0.3 mg/kg |
- Hemodynamically stable medication to maintain CPP
|
| Rocuronium |
|
1 mg/kg/dose |
|
| **Avoid ketamine due to risk for increased ICP |
|
| Asthma |
|
|
|
| Ketamine |
|
1-2 mg/kg/dose |
- Acts as bronchodilator
- May increase secretions
|
| Atropine |
|
0.02mg/kg/dose |
|
| Rocuronium |
|
1 mg/kg/dose |
|
| Respiratory Failure (Not Asthma) |
|
|
|
| Propofol |
|
1-2 mg/kg/dose |
|
| Atropine |
|
0.02 mg/kg/dose |
|
| Rocuronium |
|
1 mg/kg/dose |
|
| Sepsis |
|
|
|
| Ketamine |
|
1-2 mg/kg/dose (raises SVR) |
|
| Rocuronium |
|
1 mg/kg/dose |
|
| **Avoid Etomidate (cortisol suppression) and Propofol (hypotension) |
|
