SEVERELY COMPROMISED AIRWAY (e.g., trauma to the head and neck region),
DO NOT GIVE NM BLOCKADE AGENT UNLESS A RELIABLE SURGICAL
AIRWAY IS ON STANDBY. As a rule of thumb, use non-cuffed tubes for children <
8 years of age to avoid development of subglottic stenosis. To ensure a successful
intubation, breath sounds should be checked on both lung fields and more
importantly, CO2 should be noted on the exhaled breath either on the monitor or by
color change. A CXR should confirm the placement of the ETT.
The formula most often used to determine the appropriate size ETT is
Age + 4
4
However, approximating the size of the ETT to a child’s pinky finger or nare is also
a well-known maneuver.