According to Simon Brown:>
> Oral tubes in kids seem to be subject to a fair bit of movement, however
> well they are secured. Presumably this is related to excessive head
> movements (big occiput) and the big curl of tube in the mouth. I have found
> nasal tubes to be subject to less movement, but perhaps this is mainly due
> to the relative ease of securing at the nares, compared to the lips.
> The didactic teaching I received in anaesthesia/ICU was to convert
> paediatric intubations to nasal tubes where possible and not
> contraindicated, as soon as other functions were stabilized. This produces a
> very secure airway if the right connectors and sticky tapes are used. The
> child is also quite free to wake up and play in the ICU and is more tolerant
> of the nasal tube. When the child is paralysed and taped/collared (CSI), I
> don't think it really matters that much, and fiddling around at the base of
> the skull would be a major no-no anyway! However, prior to transport of
> non-immobilized children I would always consider converting to a nasal tube
> for extra security. Alternatively I would keep the oral tube, but paralyse
> and immobilise until getting to ICU where tube changes can be performed at
> leasure if desired. For me, as my pediatric airway skills decline in old
> age, perhaps this last option is the best!
> Dr Simon Brown
> Department of Emergency Medicine
> Royal Brisbane Hospital
> Queensland, Australia
> Email [log in to unmask]
Is there an age limit to pediatric naso-tracheal intubation in Australia ?
If not, what size would you use in a 2 years old toddler?
Steven Szabo,M.D., F.A.A.P.
UCSF/Fresno and Valley Children's Hospital
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