• Daniel D Im, Patrick A Ross, Justin Hotz, and Newth Christopher J L CJL Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. .
• Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
• Pediatr Crit Care Me. 2019 Nov 1; 20 (11): 1057-1060.

ObjectivesChest radiographs are commonly performed in the ICU setting to confirm the position of the endotracheal tube. The purpose of this study was to evaluate the practice and accuracy of repositioning endotracheal tubes in the pediatric population based on chest radiograph.DesignRetrospective review of patient's medical record and chest radiograph.SettingSingle-institution, academic children's hospital.PatientsPICU and cardiothoracic ICU patients who had repositioning of their endotracheal tube from September 1, 2016, to September 1, 2017.Measurements And Main ResultsChest radiograph before and after endotracheal tube repositioning were examined measuring the distance from the endotracheal tube tip to carina. A total of 183 endotracheal tube repositionings were assessed. Twenty-nine percent of endotracheal tube repositionings resulted in a persistently malpositioned endotracheal tube, requiring another intervention. For intended endotracheal tube repositioning of ± 2.0 cm, the actual change measured compared to intended adjustment was a median of 0.7 cm (interquartile range, 0.35-1.1 cm). For intended ± 1.5 cm, the median difference was 0.4 cm (interquartile range, 0.16-0.90 cm). For intended ± 1.0 cm, the median difference was 0.5 cm (interquartile range, 0.20-0.90 cm). For intended ± 0.5 cm, the median difference was 0.3 cm (interquartile range, 0.2-0.88 cm). When the head was malpositioned the difference from intended endotracheal tube repositioning to actual was median 0.70 cm (interquartile range, 0.40-1.1 cm), this was significantly higher than when the head was in a good position CONCLUSIONS:: When repositioning endotracheal tubes based on chest radiograph, there is a significant difference between intended and actual adjustment with great variability. Avoiding very small repositionings (± 0.5 cm) and standardizing head position prior to daily chest radiograph may reduce these errors.

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