ROUTINE CHEST RADIOGRAPHS FOLLOWING REPOSITIONING OF ENDOTRACHEAL-TUBES ARE NECESSARY TO ASSESS CORRECT POSITION IN PEDIATRIC-PATIENTS

Attempts to correctly reposition endotracheal tubes (ETTs) are not alw ays successful in pediatric patients, even when chest radiographs (CXR s) are measured to determine the distance that the ETT deviates from t he correct position. We determined the frequency of continued ETT malp osition after repositioning in a pediatric intensive care unit (PICU). Forty children with malpositioned ETTs were identified during a 4-mon th period. After repositioning, ten (25 percent) continued to be malpo sitioned on the next CXR. Of 47 children with correctly positioned ETT s, only one ETT (2 percent) was found to be incorrectly positioned on the next routine CXR obtained 24 h later. The difference in frequency of ETT malposition between these two groups of children is significant (p<0.0001). The children were similar in weight and age. Despite repo sitioning based on measurements taken from a CXR, a large percentage o f pediatric patients had continued ETT malposition. However, after rad iographic documentation of correct position, we demonstrated that sign ificant movement was uncommon. Routine confirmation of ETT position by CXRs should be considered after repositioning ETTs in pediatric patie nts.