Page 711 - ACCCN's Critical Care Nursing

688 S P E C I A LT Y P R A C T I C E I N C R I T I C A L C A R E

FIGURE 25.3 Paediatric intubation. (Courtesy Paul de Sensi.)
ventilation when a leak is undesirable, including in the
87
child with facial and airway burns, and when using
inhaled nitric oxide and for high frequency ventilatory
strategies such as oscillation ventilation. Equipment nec-
essary for paediatric intubation are shown in Figure 25.3.
Figure 25.4 shows a range of sizes of uncuffed ETTS:
2.5 mm to 5.5 mm, that should be available in 0.5 mm
increments, while cuffed ETTs are now available in sizes
from 3 mm through to 9 mm. Selecting the correct ETT
size includes having the recommended tube size plus
tubes that are 0.5 mm larger and smaller than that. For
children over 1 year of age, several formulae exist to
calculate appropriate tube sizes, but the age-based and
the fifth fingernail width-based predictions of ETT size
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are the most accurate. Table 25.4 provides a guide for
ETT sizes, suction catheter size and nasogastric tube size
for different-aged infants and children.

Practice tip
To calculate ETT tube size and length, use the following formula
from the 2010 Australian and New Zealand Resuscitation FIGURE 25.4 Range of ETT sizes. (Courtesy Paul de Sensi.)
Guidelines: 89
l For term newborns ≥3 kg: size 3.0 mm or 3.5 mm (uncuffed
tubes) or 3.0 mm (cuffed tubes) the practically simultaneous administration of hypnotic
l For infant up to 6 months: size 3.5 mm or 4.0 mm (uncuffed medication and a muscle relaxant immediately before
tubes) or 3.5 mm (cuffed tubes) intubation. 92,93 The main advantages of this method
l For infant 7 to 12 months: size 4.0 mm (uncuffed tubes) or include good airway visualisation with a relaxed jaw,
3.5 mm (cuffed tubes) open immobile vocal cords, and the elimination of all
l For children over 1 year: Uncuffed tubes: size (mm) = age movement, including gagging and coughing. 90
(years)/4 + 4 or Cuffed tubes: size (mm) = age (years)/4 + 3.5
SPECIFIC CONDITIONS AFFECTING
The most common method used to intubate children is THE UPPER AIRWAY
the rapid-sequence method. Rapid-sequence intubation Bacterial and viral infections of the upper airway are
is performed where the child may have a full stomach common in children. Croup is the most common infec-
90
and is at risk of aspiration during intubation. It involves tion causing upper airway obstruction in children.