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Objective <p>To compare the performance of an alternate nasal-tragus length (NTL) formula for the calculation of insertional length (IL) during endotracheal intubation with the standard NTL formula (NTL + 1&#xa0;cm) for optimal placement of endotracheal tube.</p> Methods <p>A randomized controlled trial was conducted in a level IIIB neonatal intensive care unit between June 2022 and December 2023. Neonates who required endotracheal intubation were randomized to either standard NTL group or alternate NTL group. In standard NTL group, the IL of ETT was calculated as NTL + 1&#xa0;cm and in the alternate NTL group, IL was calculated as IL = NTL + 0.5&#xa0;cm for a measured NTL ≤ 5.5&#xa0;cm and IL = NTL for a measured NTL &gt; 5.5&#xa0;cm.</p> Results <p>A total of 158 neonates were randomized, 79 per group. Baseline maternal and neonatal characteristics were similar. Optimal placement of endotracheal tube was more frequent in alternate NTL group than in the standard NTL group [48 (65%) and 30 (39%), respectively, <i>P</i> = 0.002]. Low placement of endotracheal tube was observed more frequently in standard NTL group versus alternate NTL group [41 (54%) vs 14 (19%); <i>P</i> &lt; 0.001]. There was no difference in other secondary outcomes such as rate of reintubation within 1&#xa0;h, need for mechanical ventilation for &gt; 72&#xa0;h, pneumothorax or other air-leak syndromes, lung atelectasis and mortality.</p> Conclusion <p>Use of alternate NTL formula in neonates requiring endotracheal intubation leads to a higher rate of optimal placement of endotracheal tube compared to standard NTL formula.</p> Trial registry <p>CTRI/2022/09/045209.</p>

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Standard Nasal-Tragus Length Formula Versus Alternate Insertional Length Formula for Optimal Placement of Endotracheal Tube in Neonates: A Randomized Controlled Trial (SNAIL Trial)

  • 期刊论文

  • 发表日期：

    2026年1月19日

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  • Sachin Dangi,
  • Anup Thakur,
  • Neelam Kler,
  • Pankaj Garg

摘要

Objective

To compare the performance of an alternate nasal-tragus length (NTL) formula for the calculation of insertional length (IL) during endotracheal intubation with the standard NTL formula (NTL + 1 cm) for optimal placement of endotracheal tube.

Methods

A randomized controlled trial was conducted in a level IIIB neonatal intensive care unit between June 2022 and December 2023. Neonates who required endotracheal intubation were randomized to either standard NTL group or alternate NTL group. In standard NTL group, the IL of ETT was calculated as NTL + 1 cm and in the alternate NTL group, IL was calculated as IL = NTL + 0.5 cm for a measured NTL ≤ 5.5 cm and IL = NTL for a measured NTL > 5.5 cm.

Results

A total of 158 neonates were randomized, 79 per group. Baseline maternal and neonatal characteristics were similar. Optimal placement of endotracheal tube was more frequent in alternate NTL group than in the standard NTL group [48 (65%) and 30 (39%), respectively, P = 0.002]. Low placement of endotracheal tube was observed more frequently in standard NTL group versus alternate NTL group [41 (54%) vs 14 (19%); P < 0.001]. There was no difference in other secondary outcomes such as rate of reintubation within 1 h, need for mechanical ventilation for > 72 h, pneumothorax or other air-leak syndromes, lung atelectasis and mortality.

Conclusion

Use of alternate NTL formula in neonates requiring endotracheal intubation leads to a higher rate of optimal placement of endotracheal tube compared to standard NTL formula.

Trial registry

CTRI/2022/09/045209.