Chest X-Ray (CXR)

Chest X-Rays are widely used in PICU. They allow for interpretation of the following:

 

- Boney structures (Fractures)

- Lung Tissue (Oedema, collapse, interstitial changes,...)

- Extra-pulmonary spaces (Pneumothorax, effusions, harm-thorax, tumor,...)

- Heart size and shape

- Diaphragmatic contour

- Position of lines and tubes

ETT positioning

GENERAL

  • Neck extension will cause the ETT to move cephalad: potentially leading to extubation

  • Neck flexion will cause ETT to move toward carina: potentially going into mainstem bronchus

  •  CXR has been found to be superior to assess ETT position over formulas or other estimations

​ADULTS

  • The carina is usually projected over T5-T7 (it descends with increasing age).

  • The desired position of an ETT in an adult is 5 ± 2 cm above the carina, but markedly varies with neck position and rotation

CHILDREN

  • The trachea is shorter, and the optimum position for the tip of the ETT is 2cm above the carina

  • When the carina cannot be visualized (usually due to technical factors) the ideal position of ETT is in the middle third of trachea at T2 to T4 level

ETT Position PICU Child
ETT Position in a Newborn
Contact/Suggestions

Juerg Burren, MBBS MD FMH (CH) EPIC FCICM

Paediatric Intensivist and Ventilation Enthusiast

​​

Tel: +61 (0) 481 751 073

info@pivares.com

© 2019-2020 by Juerg Burren for PIVARES

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