Chest X-Ray (CXR)
Chest X-Rays are widely used in PICU. They allow for interpretation of the following:
- Boney structures (Fractures)
- Lung Tissue (Oedema, collapse, interstitial changes,...)
- Extra-pulmonary spaces (Pneumothorax, effusions, harm-thorax, tumor,...)
- Heart size and shape
- Diaphragmatic contour
- Position of lines and tubes
ETT positioning
GENERAL
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Neck extension will cause the ETT to move cephalad: potentially leading to extubation
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Neck flexion will cause ETT to move toward carina: potentially going into mainstem bronchus
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CXR has been found to be superior to assess ETT position over formulas or other estimations
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​ADULTS
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The carina is usually projected over T5-T7 (it descends with increasing age).
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The desired position of an ETT in an adult is 5 ± 2 cm above the carina, but markedly varies with neck position and rotation
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CHILDREN
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The trachea is shorter, and the optimum position for the tip of the ETT is 2cm above the carina
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When the carina cannot be visualized (usually due to technical factors) the ideal position of ETT is in the middle third of trachea at T2 to T4 level
