A Comparative Study of Endotracheal Tube Positioning

Methods in Children: Safety from Neck Movement

Seung-Yeon Yoo, MD*
Jin-Hee Kim, MD, PhD*
Sung-Hee Han, MD, PhD*
Ah-Young Oh, MD, PhD

BACKGROUND: The unexpected displacement of the endotracheal tube (ETT) as a

result of neck movements can cause endobronchial intubation and accidental
extubation. The ETT is subject to movement even after its proper placement has
been confirmed either clinically or radiographically.
METHODS: One-hundred-seven children (2 8 yr) were divided randomly into three
groups. In Group I, the ETT was entered into the main bronchus and withdrawn
until equal sounds in both lung were heard, and then withdrawn 2 cm. In Group
II, the ETT position was determined by placing the prescribed marks on the ETT at
the level of the vocal cords, and in Group III, by palpating the ETT tip at the
suprasternal notch. In all groups, the distance between the ETT tip and the carina
was measured using a fiberoptic bronchoscope. The relative ETT tip position along
the trachea (carina; 0%, vocal cords; 100%) was assessed in each position during
neck movement.
RESULTS: The relative position of the ETT with the patient in the neutral position in
Groups I, II, and III was 21.4% 6.7%, 46.5% 13.0%, and 43.4% 11.1%,
respectively. In Group I, the relative ETT position after flexion was 9.5% 10.3%,
and endobronchial intubation was observed in five children (14.3%). There was no
extubation or endobronchial intubation in the other two groups.
CONCLUSIONS: Positioning the ETT by auscultation places the ETT more deeply than
the midtrachea, which can increase the risk of endobronchial intubation during
neck flexion.
(Anesth Analg 2007;105:620 5)

n pediatric anesthesia, the unexpected displacement

of the endotracheal tube (ETT) as a result of extension
and flexion of the neck can cause serious complications, such as accidental extubation and endobronchial
intubation (1). Therefore, the ideal position of the ETT
tip would allow some displacement caused by head
and neck movements but avoid these complications.
Both chest fluoroscopy and bronchoscopic evaluations can be applied effectively to verify the position
and depth of the ETT (2,3). However, fluoroscopy is
time-consuming, and the carina cannot always be
easily located. In addition, considerable training in
fiberoptic bronchoscopy (FOB) is required, and experienced operators are not always available in an
operating room when an ETT displacement is suspected. Confirmation using chest radiograph (CXR),
FOB, or fluoroscopy during the operation may still be
required when there is some question regarding ETT

From the *Department of Anesthesiology, Seoul National University Medical College, Seoul, Korea, Department of Anesthesiology, Seoul National University Bundang Hospital, Seongnam City,
Kyeonggi-do, Korea.
Accepted for publication June 4, 2007.
Address correspondence and reprint requests to Jin-Hee Kim,
MD, Department of Anesthesiology, Seoul National University
Bundang Hospital, 300 Gumi-dong, Seongnam City, Kyeonggi-do,
463-802, Korea. Address e-mail to anesing1@snu.ac.kr.
Copyright 2007 International Anesthesia Research Society
DOI: 10.1213/01.ane.0000278149.66027.0b

620

placement or when an accurate ETT depth is essential

for a particular surgical procedure (prone position or
head and neck surgery).
There are simple methods for positioning the ETT,
which consider the patients age or ETT size (4).
However, these methods are less accurate than CXR or
FOB, and there does not appear to be a strong relationship between tracheal length and these previously
described methods (4a). Some studies have reported
other simple techniques using anatomic references for
proper ETT positioning in children. The technique
proposed by Bloch et al. (1) is based on auscultation on
the bilateral chest during withdrawal of the ETT from
a deliberate right endobronchial intubation using the
carina as a reference point. Adjusting the ETT length
by noting the prescribed mark at the level of the vocal
cords has also been suggested as an effective method
for ETT positioning (4). Bednarek and Kuhns reported
that suprasternal palpation of the ETT tip is a reliable
method for positioning the tube in infants (5). Although the purpose of these methods is to place the
ETT in the ideal position, it is unclear if these positions
are safe from endobronchial intubation or extubation
during neck movement.
The aim of this study was to determine if the three
clinically prevalent methods for positioning the ETT in
children could maintain the proper positioning of the
ETT in the trachea during neck movement.
Vol. 105, No. 3, September 2007

METHODS
The local IRB of Seoul National University Hospital
approved the study protocol, and the parents of all
patients provided informed consent. One-hundredseven children (2 8 yr), scheduled to undergo elective
surgery under general anesthesia, were enrolled in
this study. Patients with pulmonary diseases, such as
bronchial asthma, abnormal breath sounds, and malformations of the trachea or bronchus on CXR, were
excluded. Patients with difficulties in neck flexion or
extension were also excluded. The patients were randomly allocated to one of three groups according to a
computer-generated random number. Induction was
performed IV with 5 mg/kg thiopental sodium. Rocuronium (0.6 mg/kg) was injected for neuromuscular
blockade. The patients were tracheally intubated with
an appropriate size tube that allowed air leakage at a
pressure of 20 25 cm H2O. The tube sizes were
determined using the formula, Age (yr)/4 4. If an
audible leak was auscultated at an inflating pressure
15 cm H2O, the tube was replaced with a tube the
next size larger. If no leak around the ETT was
auscultated at an inflating pressure 30 cm H2O, the
tube was replaced with the next smaller size. Tracheal
intubation was confirmed by the presence of an endtidal CO2 and bilateral breath sounds by auscultation.
Uncuffed tubes with a bevel facing the left and a
right-sided Murphys eye (Contour, Mallinckrodt,
Ireland) were used, which enabled the tip of the tube
to enter the right main bronchus when being advanced beyond the carina. After positioning the ETT
and providing mechanical ventilation, the length of
the ETT was measured at the upper incisor teeth and
secured to the upper lip.
In Group I, after tracheal intubation, the patient
was manually ventilated, and both lung fields were
auscultated to confirm that the ETT had been placed
correctly in the trachea. With the head held at the
midline in the neutral position, the ETT was advanced
gently until it entered a mainstem bronchus, usually
on the right side. This event was confirmed by a loss
of breathing sounds, usually on the left side. The ETT
was then slowly withdrawn until equal breath sounds
on both sides had returned. Before being secured at
the upper lip with adhesive silk tape, the ETT was
then withdrawn a further 2 cm in the children aged
between 2.0 and 5.0 yr or 3 cm in those aged between
5.1 and 8.0 yr (1).
In Group II, the standard intubation position was
used. The ETT was set at the level of the vocal cords,
such that an ETT with an internal diameter 4.0 and 4.5
mm was placed with the 4 cm mark from tip at the
vocal cords, and an ETT with an internal diameter
larger than or equal to 5.0 mm was set at 5 cm from the
tip at the cords (4).
In Group III, intubation was performed using the
modified Bednareks method (5). During intubation,
the head was placed in the standard position. The
Vol. 105, No. 3, September 2007

index finger of the palpator was placed perpendicular

to the neck at the suprasternal notch. The trachea was
compressed gently as the ETT passed the vocal cords.
The ETT tip was identified as it passed the palpating
fingertip. The person palpating the trachea instructed
the intubator to stop when the ETT tip had just passed
his fingertip. After removing the laryngoscope, the
ETT position was rechecked by withdrawing the ETT
in the neutral position, so that the tip could be
palpated again. The tube was secured with tape when
the last palpation had been achieved during a slow
re-advance of the ETT not more than 0.5 cm.
The patients were kept in an anatomically neutral
position during the bronchoscopic evaluation. The
heart rate, respiration, arterial blood pressure, pulse
oximetry, and end-tidal CO2 were monitored. A FOB
(Olympus LF-P, outer diameter 2.8 mm, Olympus
Optical CO, Japan) was inserted through an ETT/
ventilator adapter (Opti-Port, Mallinckrodt, Ireland), which allowed the procedure during mechanical ventilation. A single anesthesiologist, who was
blinded to the method of intubation, performed all the
bronchoscopic evaluations. The first mark was made
on the FOB corresponding to the proximal end of the
ETT when the tip of the FOB touched the carina. The
FOB was then withdrawn until the ETT tip was
visualized, and a second mark was made on the FOB.
The distance between these two marks on the FOB
corresponded to the distance from the tip to the carina
(T-C) (2,6). After measuring the T-C in the neutral
position, the changes in this distance were measured
after full flexion and full extension of the neck. The
angle of neck flexion and extension, which is the angle
formed by the operation table and a line drawn from
the spinous process of C7 to the posterior part of
occiput, was measured using a goniometer. When
endobronchial intubation was suspected with a bronchoscopic examination, the ETT distance in the main
bronchus was measured by withdrawing both the ETT
and bronchoscopy to the carina. The relative ETT tip
depth along the trachea ( distance from the carina to
the ETT tip/tracheal length, carina; 0%, vocal cords;
100%) was assessed in each position during neck
movement. The tracheal length was measured in the
neutral position using Hartrey and Kestins method
(6,7). This procedure involved withdrawing the bronchoscope and ETT from the trachea as a single unit,
beginning with the bronchoscope at the carina, and
stopping when the vocal cords were just visible through
the bronchoscope. At this point, a mark was made on the
ETT at its point of exit from the upper lip, and the
tracheal length was indicated by the amount of tube
removed. Each procedure lasted for no more than 30 s.
The number of patients required to demonstrate a
difference in the T-C was calculated with the assumption that a 30% change in the distance between the
ETT tip and the carina would be clinically relevant.
Power analysis suggested that a minimum of 29
patients would be needed for 0.1 and 0.05.
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Table 1. Demographic Patient Data

Patient
Sex (M/F)
Age (mo)
Weight (kg)
Height (cm)
Internal diameter of E-tube (mm)
Type of surgery
Opthalmologic
Otologic
Urologic
Abdominal

Group I

Group II

Group III

n 35
17/18
59.9 22.5
20.3 7.0
108.5 13.5
5.5 0.6

n 36
23/13
54.7 17.0
19.8 7.1
107.2 11.2
5.3 0.4

n 36
26/10
62.4 24.4
21.5 7.3
114.0 14.2
5.6 0.2

0.909
0.249
0.738
0.295
0.107
0.216

7
16
6
6

4
17
10
5

8
13
10
5

The data are represented as mean SD.

Group I: using auscultation; Group II: using prescribed marks; Group III: using palpation.
E-tube endotracheal tube.

Table 2. Measured Tracheal Length, Distance Between the Endotracheal Tube Tip and Carina, Change in the Distance Between the
Endotracheal Tube Tip and Carina After Neck Movement, and the Angle of Neck Movement in Each Group
Tracheal length (cm)
T-C neut (cm)
T-C flex (cm)
T-C ext (cm)
T-C flex-neut (cm)
T-C ext-neut (cm)
Angle flex ()
Angle ext ()

Group I

Group II

Group III

7.9 1.1 (5.2 to 10.0)

1.7 0.5
0.7 0.8
3.4 0.8
0.9 0.7 (2.1 to 0.5)
1.8 0.7 (0.7 to 3.6)
43.6 5.6
47.6 7.2

7.8 0.9 (6.2 to 9.7)

3.6 1.0
3.0 1.0
5.5 1.2
0.6 0.5 (2.1 to 0.2)
1.9 0.7 (0.6 to 3.2)
44.5 3.7
49.4 5.4

7.8 1.0 (6.3 to 10.0)

3.4 0.9
2.5 1.0
5.3 1.0
0.9 0.6 (2.6 to 0.0)
1.9 0.7 (0.1 to 3.1)
43.4 4.2
46.7 4.5

0.298
0.05
0.05
0.05
0.726
0.284
0.073
0.171

Group I: using auscultation; Group II: using prescribed marks; Group III: using palpation.
flex neck flexion; ext neck extension; T-C distance between the endotracheal tube tip and carina; T-C change in the T-C after neck movement.

Table 3. Relative Depth of the Endotracheal Tube (ETT) Tip from the Carina to the Vocal Cords in the Trachea
T-neut (%)
T-flex (%)
T-ext (%)

Group I

Group II

Group III

21.4 6.7
9.5 10.3
44.3 12.1

46.5 13.0
38.3 13.4
71.7 16.1

43.4 11.1
32.4 12.5
67.9 14.7

0.05
0.05
0.05

Group I: using auscultation; Group II: using prescribed marks; Group III: using palpation. Relative position of the ETT tip: the ETT tip at the carina and vocal cords was considered to be 0% and
100%, respectively.
T-neut distance from the carina to the ETT tip in the neutral position/tracheal length; T-flex distance from the carina to the ETT tip in full flexion of the neck/tracheal length; T-ext distance
from the carina to the ETT tip in full extension of the neck/tracheal length.

Thirty-five to 36 patients were examined in each

group to allow for any methodological difficulties that
could lead to exclusion from the study. Statistical
analysis was performed using SPSS 11.0 for Windows
(SPSS, Chicago, USA). The frequency of endobronchial intubation was compared using a Pearsons 2
test. The Cochran-Mantel-Haenszel statistic was calculated to evaluate age as a possible confounding variable. The difference between the T-C and the intended
distance from the carina was analyzed using one
sample Students t-test. The differences among the
groups were analyzed using ANOVA, which was
followed by a StudentNewmanKeuls correction if
necessary. Statistical significance was established at
P 0.05. The data are represented as the mean sd.

RESULTS
Table 1 shows the demographic data of the patients.
The tracheal length and displacement of the ETT tip
622

Safety of Endotracheal Tube Positioning

after neck flexion or extension was similar in the

three groups (Table 2). The ETT migrated upward to
the vocal cords during neck extension and downward to the carina during neck flexion. There were
significant differences in the T-C in the neutral
position (1.7 0.5 cm in Group I, 3.6 1.0 cm in
Group II, and 3.4 0.9 cm in Group III, P 0.05,
Table 2). In addition, Group I showed a significantly
deeper ETT position in the neutral position (1.7
0.5 cm) than the intended depth, which was 2 cm
above the carina (P 0.05).
In Group I, the relative position of the ETT tip along
the trachea in the neutral position was 21.4% 6.7%,
which is closer to the carina than to the vocal cord (Table
3). The relative position of the ETT tip in Groups II and
III was 46.5% 13.0% and 43.4% 11.1%, respectively,
which corresponded to the midtrachea.
After full neck flexion, the relative position of the
ETT tip in Group I was 9.5% 10.3%, which is closer
ANESTHESIA & ANALGESIA

Figure 1. Relative depth of the endotracheal tube tip from the carina in Group I. The carina and vocal cords were considered
to be the zero and 1.0 point, respectively. (: relative depth in neutral position;
: relative depth after full flexion; : relative
depth after full extension).

Figure 2. Relative depth of the tip from the carina in Group II. The carina and vocal cords were considered to be the zero and
1.0 point, respectively. (: relative depth in neutral position;
: relative depth after full flexion; : relative depth after full
extension).

to the carina than that observed in the other groups

(P 0.05, Table 3). Five cases of endobronchial
intubation were observed after full flexion of the neck
in Group I, particularly in children aged between 2
and 5 yr (Fig. 1). In the other groups, neither endobronchial intubation nor extubation from the trachea
was observed after neck flexion or extension (Figs. 2
and 3). Age was not found to be a confounding
variable in the three groups. All patients were
followed-up for any airway complications at the postanesthesia care unit and ward (particularly in Group
Vol. 105, No. 3, September 2007

III). There were no postextubation airway complications encountered.

DISCUSSION
The ETT can be displaced as a result of the neck
movement causing accidental endobronchial intubation or extubation from the trachea (1,4). Therefore, it
is extremely important to accurately place the ETT to
a predetermined depth to ensure safety during neck
movement. Several techniques for positioning the ETT
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Figure 3. Relative depth of the tip from the carina in Group III. The carina and vocal cords were considered to be the zero
and 1.0 point, respectively. (: relative depth in neutral position;
: relative depth after full flexion; : relative depth after
full extension).

correctly have been described. According to previous

studies, the ETT can be positioned 2.06 (1) or 1.93 cm
(8) above the carina by deliberately intubating the
patients right main bronchus and then withdrawing
the ETT 2 cm into the trachea. However, these results
showed that the ETT tips were placed only 1.7 cm
above the carina in Group I, even though they had
been placed using the same method. In addition, the
results were significantly different from the intended
ETT position, i.e., 2 cm above the carina. The reason
why these results were different from previous studies
is unclear. However, Sugiyama et al. (9) reported that
bilateral breath sounds are equally audible when the
ETT tip is advanced 2 cm beyond the carina in adults,
suggesting gas flow to the contralateral lung through
the Murphy eye. Therefore, it is possible that the
Murphy eye can maintain the appropriate gas flow to
the left lung and allow equal breath sounds on both
sides when the ETT tip is placed below the carina in
the right main bronchus. This might contribute to the
deeper than intended depth of the ETT, which would
have increased the risk of endobronchial intubation in
Group I.
Mariano et al. (3), in a fluoroscopic study, reported
that deliberate mainstem intubation combined with
auscultation resulted in an appropriate ETT placement
(73%) more often than when using the marker (53%)
and formula methods (42%). The results that favor
deliberate mainstem intubation may be derived from
the criterion of appropriate ETT depth, which is the
location of the ETT tip between the sternoclavicular
junction and 0.5 cm above the carina. In this study, 34
of 35 patients in Group I met the criterion in the
neutral position in the bronchoscopic study. According to the criterion, deliberate mainstem intubation
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Safety of Endotracheal Tube Positioning

reliably results in an appropriate ETT depth. However, there were five cases of endobronchial intubation
after neck flexion.
Bloch et al. (1) suggested, through auscultation of
the bilateral lung sound, that the proper position of
the ETT was 2 cm (in children under 5 yr) or 3 cm (in
children over 5 yr) above the carina. Neck flexion
causes the ETT tip to move towards the carina, thereby
shortening the distance between the tip and the carina.
In children aged between 16 and 19 mo, the ETT tip
moved a mean distance of 0.9 cm with a maximum
movement of 1.2 cm (10). Therefore, an ETT positioned 2 cm above the carina can be considered to be
safe from endobronchial intubation during neck flexion in children under 2 yr. However, the position of
the ETT in children over 2 yr needs to be modified. In
this study, the relative position of the ETT tip in
Group I was 20.9% 6.7%, which was placed closer to
the carina than to the vocal cord, and may have
increased the risk of endobronchial intubation during
neck flexion. Indeed, the relative position of tip from
the carina in Group I decreased to 11.0% 10.3% after
full neck flexion, resulting in endobronchial intubation in 14.3% of children. Moreover, endobronchial
intubation occurred only in those children aged between 2 and 5 yr, in whom the aim was to place the
ETT tip 2 cm above the carina. Consistent with these
results, Verghese et al. (11) reported that a low tracheal position and right mainstem intubation occur
more often in children younger than 10 yr, and
particularly in younger children with a lower body
weight.
On the other hand, the relative positions of the ETT
tip in the neutral position in Groups II and III were
46.7% 13.3% and 43.8% 10.9%, respectively. The
ANESTHESIA & ANALGESIA

positions of the ETT tip were in accord with the

midtrachea, which is consistent with the results reported by Freeman et al. and Bednarek and Kuhns
(4,5). The midtrachea is considered to be the ideal
depth for an ETT (12,13). The tracheal length in
children 2 8 yr has been reported to be 6.4 8.2 cm
(14) and 7.9 cm (6). In this study, the tracheal length of
this age group was 7.8 0.9 cm, whereas the displacement of the ETT was 0.8 0.6 cm (max: 2.6 cm) to the
carina after neck flexion, and 1.9 0.7 cm (max: 3.6
cm) to the vocal cords after neck extension. These
results show that, despite full flexion or full extension
of the neck, there was no endobronchial intubation or
extubation in the patients in whom the ETT was
positioned using these two methods. Therefore, the
midtrachea can be considered safe from neck movement in children aged between 2 and 8 yr. Palpation of
the ETT tip on the suprasternal notch has been suggested as a method that allows the midtracheal positioning of the ETT in newborns and infants (5). These
results show that this method can be used safely and
effectively in children aged between 2 and 8 yr. In
addition, this method has been suggested to be useful
in emergency situations, or on initial intubations, to
avoid improper positioning of the ETT tip (5). However, this method may damage the tracheal mucosa or
stimulate a hypersensitive reaction. Therefore, gentle
and sensitive handling may be needed.
Freeman et al. (4) reported that the midtracheal
positioning of the ETT could be achieved in 79% of
patients aged 0 14 yr by setting the tube length at the
level of the vocal cord, such that an ETT with an
internal diameter of 3.0 and 3.5 could be set 3 cm from
the tip at the cords, 4.0 and 4.5 tubes at 4 cm, and 5.0
and 5.5 tubes at 5 cm. The advantage of this technique
is that it is easily remembered and setting the tube
length at the level of the vocal cord reduces the
variability due to the length of the upper airway. In
addition, this black safety line on the ETT positioned
at the level of the vocal cords has been used as a guide
in neonates (15). The results in this study showed this
method to be effective for avoiding endobronchial
intubation or extubation in older children without
creating any difficulties in visualizing the vocal cords.
However, the depth markers are not found in the
same location in different brands of ETT (13,16).
Therefore, the distances of the depth marker from
the ETT tip should be identified before tracheal
intubation.
None of the methods examined is expected to result
in the appropriate placement of the ETT in all cases. In
addition, variability in the tracheal length among
patients makes it impossible to predict with certainty
that a technique based on a formula or markers on the
ETT will work in all patients. FOB or CXR can be used

Vol. 105, No. 3, September 2007

to confirm the correct placement of the ETT. FOB has

been used to confirm the correct placement of the ETT,
but this technique is not widely available. CXR remains the gold standard for confirming appropriate
tube placement (17).
In conclusion, positioning the depth marker at the
vocal cord level and palpation of the ETT tip on the
suprasternal notch in children aged between 2 and 8
yr prevented endobronchial intubation and accidental
extubation caused by neck flexion but positioning the
ETT 2 cm above the carina by auscultation did not.
REFERENCES
1. Bloch EC, Ossey K, Ginsberg B. Tracheal intubation in children:
a new method for assuring correct depth of tube placement.
Anesth Analg 1988;67:590 2
2. Reyes G, Ramilo J, Horowitz I, Freter AE, Husayni T, Sulayman
R, Jaimovich DG. Use of an optical fiber scope to confirm
endotracheal tube placement in pediatric patients. Crit Care
Med 2001;29:1757
3. Mariano ER, Ramamoorthy C, Chu LF, Chen M, Hammer GB. A
comparison of three methods for estimating appropriate tracheal tube depth in children. Paediatr Anaesth 2005;15:846 51
4. Freeman JA, Fredricks BJ, Best CJ. Evaluation of a new method
for determining tracheal tube length in children. Anaesthesia
1995;50:1050 2
4a.Phipps LM, Thomas NJ, Gilmore RK, Raymond JA, Bittner TR,
Orr RA, Robertson CL. Prospective assessment of guidelines for
determining appropriate depth of endotracheal tube placement
in children. Pediatr Crit Care Med 2005;6:519 22
5. Bednarek FJ, Kuhns LR. Endotracheal tube placement in infants
determined by suprasternal palpation: a new technique. Pediatrics 1975;56:224 9
6. Jin-Hee K, Ro YJ, Seong-Won M, Chong-Soo K, Seong-Deok K,
Lee JH, Jae-Hyon B. Elongation of the trachea during neck
extension in children: implications of the safety of endotracheal
tubes. Anesth Analg 2005;101:974 7
7. Hartrey R, Kestin IG. Movement of oral and nasal tracheal tubes
as a result of changes in head and neck position. Anaesthesia
1995;50:6827
8. Kim KO, Um WS, Kim CS. Comparative evaluation of methods
for ensuring the correct position of the tracheal tube in children
undergoing open heart surgery. Anaesthesia 2003;58:889 93
9. Sugiyama K, Yokoyama K, Satoh K, Nishihara M, Yoshitomi T.
Does the Murphy eye reduce the reliability of chest auscultation
in detecting endobronchial intubation? Anesth Analg 1999;88:
1380 3
10. Sugiyama K, Yokoyama K. Displacement of the endotracheal
tube caused by change of head position in pediatric anesthesia:
evaluation by fiberoptic bronchoscopy. Anesth Analg 1996;82:
2513
11. Verghese ST, Hannallah RS, Slack MC, Cross RR, Patel KM.
Auscultation of bilateral breath sounds does not rule out
endobronchial intubation in children. Anesth Analg 2004;
99:56 8
12. Conrardy PA, Goodman LR, Lainge F, Singer MM. Alteration of
endotracheal tube position. Flexion and extension of the neck.
Crit Care Med 1976;4:712
13. Goel S, Lim SL. The intubation depth marker: the confusion of
the black line. Paediatr Anaesth 2003;13:579 83
14. Griscom NT, Wohl ME. Dimensions of the growing trachea
related to age and gender. AJR Am J Roentgenol 1986;146:2337
15. Loew A, Thibeault DW. A new and safe method to control the
depth of endotracheal intubation in neonates. Pediatrics 1974;
54:506 8
16. Wallace CJ, Bell GT. Tracheal tube markings. Paediatr Anaesth
2004;14:2835
17. Salem MR. Verification of endotracheal tube position. Anesthesiol Clin North America 2001;19:81339

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