Efficacy of modified Tochen’s formula for optimum endotracheal tube placement in low birth weight neonates- an RCT

Abstract:Objective: To study the effectiveness of modified Tochen’s formula (hereafter known as the alternative formula) when compared to Tochen’s formula for optimal placement of endotracheal tubes in LBW neonates.Study Design: A randomized controlled trial conducted in 70 neonates. Neonates requiring intubation for ventilation, with a confirmatory chest radiograph, were included in the study. They were intubated using Tochen’s formula (birth weight in kg + 6cm) or Alternative formula (birth weight in kg + 5cm). Tube tip placement was verified and modified, if necessary, after auscultation. The incidence of inadequate placement and optimum length of ET insertion were estimated from the chest radiographs. Incidence of adverse events in the two groups were noted.Results: A total number of 92 babies were eligible for the study. One family refused consent and twenty-one families could not be approached and hence not included in study. A total of 70 neonates were randomized and included in the study; 34 in Tochen’s group and 33 in alternative formula group. Baseline characteristics between the two groups had no statistically significant differences (p-&gt;0.05).Measurements in the alternative formula group were significantly (p - 0.006) closer to the optimal position (distance from optimum - 0.50 cm ± 0.41) when compared to Tochen’s group (distance from optimum - 0.86 cm ± 0.06) The adverse events were significantly (p- 0.005) greater in the group that was intubated using Tochen’s formula (16 of 34, 47.05%) when compared to the group where the alternative formula was applied (5 of 33, 15.15%). Though the percentage of optimum (8 of 33, 24.24%) and adequate placements (29 of 33, 87.87%) of the ET tube was higher in the group of the alternative formula when compared to the optimal (3 of 34, 8.82%) and adequate placement (24 of 34, 70.58%) of ET tube in the Tochen’s group, this was not statistically significant (p- &gt;0.05). The depth of ET placement was found to be overestimated in the Tochen’s group as compared to the group of the alternative formulaConclusion: The incidence of adequate and optimal placement of ET tube was higher in alternative formula group and the distance from optimal was significantly smaller when compared to the Tochen’s group. The adverse events were significantly fewer in the alternative formula group. Hence, the use of the alternative formula in low birth weight babies may enable the more accurate placement of ET tubes in low birth weight babies when compared to the Tochen’s formula.<br>