Final answer:
To select the correct cuffed ET tube size, consider the patient's anatomy and use the pediatric formula for children, which is (Age/4) + 3.5 for those over 2 years. Adult sizes typically range from 7.0-8.5 mm, and proper inflation of the cuff is crucial to provide a seal and avoid tracheal damage. Multiple sizes should be available during intubation, and placement must be confirmed using chest radiography, end-tidal CO2, and auscultation.
Step-by-step explanation:
To select the correct size for a cuffed endotracheal (ET) tube, one must consider several factors. While specific guidelines may vary depending on the institution, for an adult patient, the internal diameter of the ET tube commonly ranges from 7.0 to 8.0 millimeters (mm) for females and 7.5 to 8.5 mm for males. However, the appropriate size is ultimately determined by the patient's anatomy and the clinician's judgment. A useful pediatric formula to estimate the correct size for a cuffed ET tube is to use the patient's age: (Age in years / 4) + 3.5 for children over 2 years of age. It is important to have a tube that fits appropriately, as a tube that is too large can cause trauma and complications, while one that is too small can lead to inadequate ventilation and airway leak.
When preparing to intubate a patient, it is good practice to have multiple sizes of ET tubes available. Generally, the cuff should be inflated enough to provide a seal against the tracheal wall without exerting excessive pressure, as to prevent injury to the tracheal mucosa. Clinicians often check for an air leak at a specific positive pressure to ensure proper fit. Once the tube is in place, correct placement should be confirmed with chest radiography, end-tidal CO2 monitoring, and auscultation.