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Malposition of the endotracheal tube is a frequent complication in patients being treated for ventilatory failure. It was suspected that motion of the head might alter the position of the tube and result in malposition. Twenty adult patients with ventilatory failure, in tubated with an 8.0-mm endotracheal tube (5 oral and 15 nasal) were studied. The cuff was deflated in 10 of the 20 patients. With the patient in a semierect sitting position, standardized portable anterior-posterior chest roentgenograms were obtained with the neck in flexion, neutral, and hypertension and in 5 of the patients after right lateral head rotation. Movement of the endotracheal tube tip relative to the carina was measured from each roentgenogram.

The endotracheal tube moved a similar distance regardless of the route of intubation or the inflation status of the cuff. Therefore, all groups were combined for analysis. The tube moved an average of 1.9 cm toward the carina with flexion from a neutral position, 1.9 cm away from the carina with extension, and 0.7 cm away with lateral head rotation.

Malposition of the endotracheal tube may result from changes in head position. To minimize the possible injurious effects of that malposition, we recommend that the tip of the endotracheal tube be placed in the middle third of the trachea with the neck in a neutral position. Finally, knowledge of the head position is crucial to the proper radiographic interpretation of endotracheal tube position.

(C) Williams & Wilkins 1976. All Rights Reserved.