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Accuracy of Advanced Pediatric Life Support Intubation Depth Formula in Indian Children Aged 1 to 12 Years

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Abstract

Objective

To evaluate the accuracy of the Advanced Pediatric Life Support (APLS) endotracheal tube (ET) depth formula in Indian children aged 1 to 12 years.

Methods

We enrolled 86 children aged 1–12 years requiring intubation and ventilation. The ET depth was determined using the APLS formula, and chest X-rays were utilized to evaluate ‘appropriate ET depth (accuracy)’ based on ‘vertebral level criteria’ and ‘safe distance between ET tip and carina.’

Results

Out of 86 cases, none had bronchial intubation. An accuracy of 37.2% (32 cases) was observed, with 57% (49 cases) showing deep placement. Among deep placements, 11 met ‘vertebral level criteria’ but not ‘safe distance criteria.’ Redefining deep placement based solely on ‘safe distance criteria,’ resulted in 50% accuracy.

Conclusion

APLS formula effectively prevents bronchial intubation in Indian children, but tends to overestimate ET depth (50% cases) when considering the ‘safe distance between ET tip and carina.’

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Funding

Funding: None

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Authors and Affiliations

  1. Department of Pediatrics, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

    Sagar Agrawal,  Vishal Kumar, Maansi Gangwal,  Komal & Bijoy Patra

  2. Department of Radiodiagnosis, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, India

    Shahina Bano

  3. 1203, JM Park Sapphire, Ramprastha Greens, Vaishali, Ghaziabad, 201 010, Uttar Pradesh, India

    Vishal Kumar

Authors
  1. Sagar Agrawal
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  2. Vishal Kumar
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  3. Maansi Gangwal
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  4. Komal
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  5. Bijoy Patra
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  6. Shahina Bano
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Contributions

Contributors: VK: conceived the idea; SA, VK: conceptualized the study and devised its design; SA, MG, K: collected the data; BP, SB: analyzed and interpreted the data and provided critical inputs; VK, BP, SB: supervised data collection and helped in the conduct of the study; SA, MG, K: drafted the manuscript. VK, BP, SB: critically reviewed and revised the manuscript. All the authors read and approved the final manuscript, and agree to be accountable for all aspects of the study.

Corresponding author

Correspondence to Vishal Kumar.

Ethics declarations

Ethical clearance: Institutional Ethics Committee, ABVIMS & Dr RML Hospital, New Delhi; No. IEC/ABVIMS/RMLH714/19, dated Oct 22, 2019.

Competing interests: None stated.

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Agrawal, S., Kumar, V., Gangwal, M. et al. Accuracy of Advanced Pediatric Life Support Intubation Depth Formula in Indian Children Aged 1 to 12 Years. Indian Pediatr 60, 997–1000 (2023). https://doi.org/10.1007/s13312-023-3062-3

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  • DOI: https://doi.org/10.1007/s13312-023-3062-3

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