• Brenda V Marcano, Peter Silver, and Mayer Sagy.
• Albert Einstein College of Medicine, Division of Pediatric Critical Care Medicine, Schneider Children's Hospital, New Hyde Park, NY 11040, USA.
• Pediatr Crit Care Me. 2003 Apr 1;4(2):186-9.

ObjectiveTo test the hypothesis that prone positioning of patients with acute respiratory distress syndrome results in significant cephalad movement of their endotracheal tubes (ETT).DesignA retrospective review of chest radiographs and patient information.SettingPediatric intensive care unit of a children's hospital.Measurements And Main ResultsPatients with acute respiratory distress syndrome had digital chest radiographs performed before and immediately after prone positioning as per our routine practice. Based on measurements of the length of the thoracic trachea and the length of the thoracic segment of the ETT, the movement of the ETT subsequent to prone positioning was calculated. Fifteen pairs of radiographs of 14 consecutive patients were evaluated. There were seven girls and seven boys, with ages ranging from 2 months to 18 yrs. All patients had a cephalad movement of their ETT ranging from 10% to 57% of their thoracic tracheal length (p < .001) associated with prone positioning. The mean amplitude of this movement was 34% +/- 16%, indicating that if the tip of the ETT is not deeper than one third of the thoracic tracheal length before prone positioning, it might slide into the cervical trachea as a result of this procedure.ConclusionsProne positioning results in cephalad movement of ETT within the trachea. The tip of the ETT should be deeper than one third of the total length of the thoracic trachea before prone positioning to prevent it from moving into the cervical trachea. When prone positioning is done with an ETT originally not deeper than one third of the thoracic trachea, obtaining a chest radiograph immediately after prone positioning is important to determine whether the ETT remained safely situated in the trachea.

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