In children, the trachea is shorter, and the optimum position for the tip of the ETT is 1.5 cm above the carina. The desired position of an ETT is 5 ± 2 cm above the carina, but markedly varies with neck position and rotation and hence, the inclusion of the mandible is a helpful indicator: The carina is usually projected over T5-T7 (it descends with increasing age). When flexed, the mandible projects around T1 and in extension, over C3/C4. In a neutral position, the lower border of the mandible should be projected over C5/C6. If included in the film, the mandible can be used for assessment of whether the neck is in a neutral position. If the neck is flexed, the tip of the tube descends in the trachea. The position of the ETT is dependent on the position of the head. ETT position is usually assessed on a frontal chest radiograph.
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