2Dr Brock: Selecting the appropriate endotracheal tube size and length can be a challenge because of the variety of patient sizes and facial configure that we work with. it is important to have a variety of sizes of tubes to select from.
Be cautious about over-reliance of charts and methods of selecting a tube, such as the nasal philthrum size. Likely the tube that will be selected from the chart or method will. likely be a small size, so also choose sizes that are larger.
I like to start by palpating the size of the trachea. For the length, place the ET lateral to the face and neck and the tube should stop forward to the point of the shoulder. You can also easily shorten the ET tube to the correct length. It is a good idea to have several tubes of one size in different lengths.
Once intubated, there should only a be a small amount of tube protruding from the dental arcade. This way the dead space is minimized but also safely positioned within the mouth. If the ET is longer than necessary, you can get an endobronchial intubation which will result in only half the lung volume receiving oxygen and gas. Hypoxemia is the common result.
