Experience with the illuminated endotracheal tube in the prevention of unsafe intubations in the premature and full-term newborn

To determine whether an endotracheal tube modified by incorporation of a fiberoptic strand in the wall and connected to a light source could be safely and reliably positioned in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch of the chest wall. All newborns in the Vanderbilt Neonatal Intensive Care Unit who were candidates for intubation by established clinical criteria, who were not already intubated, were candidates for the study. We defined optimal placement of the endotracheal tube to be one with the tip of the tube below the first thoracic vertebral body and no less than 0.5 cm above the carina or at T-4 (if the carina could not be seen on the radiograph). A light source was connected to the fiberoptic strand and the endotracheal tube positioned so that a circle of light was visible on the skin of the chest wall at the suprasternal notch. In all 22 placements, the tube tip was below the larynx and above the carina. In 20 of the placements, the position was optimal between T-1 and T-4, whereas in the other 2 the tube tip was high between the larynx and the thoracic inlet. This system required that an endotracheal tube 0.5 mm smaller than usually used be utilized because of the slight increase in outer diameter due to the fiberoptic strand. Conventional suction catheters were used in this study. This study has shown that the illuminated endotracheal tube is a reliable device for accurate positioning in premature and full-term newborns using transdermal siting of a bright spot on the skin at the suprasternal notch.