Flexible intubating video endoscope-guided determination of optimal oral endotracheal tube depth in infants: a prospective observational study

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Source: Frontiers Medicine

Original: https://www.frontiersin.org/articles/10.3389/fmed.2026.1749293...

Published: 2026-03-13T00:00:00Z

The study assessed the accuracy of the APLS and NRP formulas for predicting oral endotracheal tube (ETT) depth in Chinese infants aged 1–12 months undergoing elective surgery and developed a new formula validated with a flexible intubation video endoscope (FIVE) where the tip of the tube was positioned 1 cm above the carina. In neonates, FIVE-depth was correlated with height (r=0.670, P<0.001), weight (r=0.488, P<0.001) and body surface area (BSA). In infants 1–12 months, correlations were stronger with height (r=0.952, P<0.001), weight (r=0.895, P<0.001), BSA (r=0.926, P<0.001) and age (r=0.871, P<0.001). APLS and NRP formulas predicted a deeper depth than FIVE in 12.5% ​​of neonates and 30.1% of older infants. The new formula for infants 1–12 months is: depth (cm) = 4.5 + 0.1 × height (cm). The weight-based APLS formula is less applicable to Chinese infants, while the height-based formula better corresponds to FIVE-depth. The model requires independent external validation before clinical use.