Assessment of the proper depth of endotracheal tube placement with the trachlight

Abstract Study objective: To test the hypothesis that the correct depth of the endotracheal tube can be confirmed by transillumination method using the Trachlight™ device, which is a newly introduced lighted stylet for guided, blind tracheal intubation. Design: Prospective, nonrandomized pilot-trial. Setting: University-affiliated hospital. Patients: 72 intubated and mechanically ventilated critically ill adult patients. Interventions: Patients were briefly disconnected from the respirator. The centimeter marks of the Trachlight™ catheter were brought into line with those of the endotracheal tube, resulting in congruence of the bulb of the Trachlight™ and the tube tip. Measurements and Main Results: To measure the distance from the tip of the tube to that of the sternal notch, the Trachlight™ wand was retracted without moving the endotracheal tube until the bright light appeared in the sternal notch. A chest radiograph was taken to measure the distance between the carina and the tip of the tube. The Trachlight™ showed a distance of 4.0 ± 1.3 cm from the tip of the tube to the sternal notch. Chest radiography revealed a distance of 3.3 ± 1.6 cm between the carina and the tip of the tube, so that the calculated distance between sternal notch and carina was 7.3 ± 1.5 cm. Conclusion: To achieve proper depth of the endotracheal tube, it is recommended that the tip of the endotracheal tube be placed 3 cm beyond the sternal notch. The Trachlight™ provides a simple and easy technique to achieve this goal.