Pediatrics: What Size ETT Should You Choose?

The patients I work with are mostly adults. I would say that about 95% of the patients I care for are adults. But, being a small hospital, I also have to take care of neonates and pediatrics when they come to our emergency room. So, while we are experts in how best to manage adults, we also have to keep our neonatal and pediatric skills up. 

That said, recently I was informed there was a car accident. And a kid was coming to our trauma room. So, I rushed to the trauma room and was standing there waiting for the kid to arrive. And a thought rushed through my head, a logical though. And it was this: "When the kid arrives, what size ETT do I pick out for the doctor?"

For adults, I know exactly what ETT to choose. If it is a male, I go with a size 8. If it is a female, I go with a size 7.5. If it is a really small male I might go with a 7.5. And if it is a really small girl I may go with a 7 or maybe even a 6.5. But, 99% of the times it's a 7.5 and an 8. And that's what I would have ready. 

If you work with neonates and pediatrics every day, you probably know what tube to grab. And, several years ago, I created a cheat sheet for my coworkers and myself to use. And, for the longest time, I had the size of ETT memorized. But, time has gone by and I have forgotten. So, I have decided it's time to recreate this cheat sheet and for this review. 

So, what size ETT do you select? Where do you secure the tube? Here's my cheat sheet. 

Neonatal

Gestational Age	Weight Grams	ETT Size	Secure at the lip
Below 28	Below 1,000	Below 28	7
28-34	1,000 - 2,000	28-34	9
34-38	2,000 - 3,000	34-38	9 or 10
40 and above	3,000 plus	38 and above	10

Pediatric. 

Age	Wt Kg	ETT Size*	Secure at lip
3-6 months	5.5-7	3.5  or  4	10
1 year	10	4   or  4.5	11
2 year	12	4.5  or  5	12
3 year	14	5 uncuffed or 4.5 cuffed	13
4 years	16	5.5 uncuffed or 5 cuffed
5 years	18	5.5 uncuffed or 5 cuffed	15
6-7	20-22	6 uncuffed or 5.5 cuffed
8-10	25-30	6  or  6.5 cuffed	18
10-12	30-35	6.5 cuffed
12-14	40-45	7  cuffed

*Formula for uncuffed tube is 4+age/4     ** Formula for cuffed is 3.5+age/4

Keep in mind that this is just guide for you. For example, a 3 year old child may require a 6.0 tube. Although, a 3 year old child may also be the size of an average 5 year old and require a 5.5 tube. So, you will have to use your judgement here as to what size is best for the child in front of you.

Or, if you have access to it, you may be better off using broselow tape. This is a color coded tape that you stretch out the length of the child. And the child's height determines what color you will use. To use it, you must have the child lying flat on the bed. Hold the red end of the tape by the child's head. While holding this end of the tape, run the rest of it all the way down to the child's toes. The color at this mark indicates both the child's weight and color. The color refers to what drawer in the pediatric crash card you will open. And everything you need for that child (such as the appropriate ETT) will be in that drawer. If the child is taller than the tape, then you treat the patient as you would an adult. 

Even with the broselow tape, the cheat sheet above will come in handy as it will help you determine where to secure the ETT. The broselow tape will give you the estimated weight of the child in kg. This can also be helpful for helping you pick out which lopro to use. On each lopro is the estimated kg in weight that that lopro is supposed to be used for. This can help you choose the best lopro. 

If you want a copy of the above cheat sheet feel free to cut and past and print it up from your own word document. If you are cheap like me, Google Documents works great for this.