{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T06:08:58Z","timestamp":1744178938002},"reference-count":25,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,5,29]],"date-time":"2015-05-29T00:00:00Z","timestamp":1432857600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"Department of Anesthesiology and Pain Management, Seattle Children's Hospital"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Knowledge of the normal nares\u2010to\u2010carina (<jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content>) distance might prevent accidental bronchial intubation and be helpful when designing preformed endotracheal tubes (<jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>The aim was to measure <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> distance and to examine whether a height\/length\u2010based \u2018modified Morgan formula\u2019 would give useful guidance for nasotracheal <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> depth positioning.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Two groups were studied. A younger group consisted of nasally intubated postoperative patients. In these, <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> distance was obtained as the sum of <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> length and the distance from the <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> tip to the carina, as measured from an anteroposterior chest X\u2010ray. An older group consisted of children who had undergone computerized tomography (<jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content>) examination including head, neck, and chest. In these, <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> was measured directly from the <jats:styled-content style=\"fixed-case\">CT<\/jats:styled-content> image. The modified Morgan formula was derived from the <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> vs height\/length relationship.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Nares\u2010to\u2010carina distance was best predicted by a linear equation based on patient height. The equation in the younger group (1\u00a0day\u20138\u00a0years, <jats:italic>n<\/jats:italic>\u00a0=\u00a057) was: <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> (cm)\u00a0=\u00a00.14\u00a0\u00d7\u00a0height\u00a0+\u00a05.8, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.90, and in the older group (2.1\u201320\u00a0years, <jats:italic>n<\/jats:italic>\u00a0=\u00a045): <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> (cm)\u00a0=\u00a00.15\u00a0\u00d7\u00a0height\u00a0+\u00a03.4, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.93. The equation for the groups combined (<jats:italic>n<\/jats:italic>\u00a0=\u00a0102) was: <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> (cm)\u00a0= 0.14\u00a0\u00d7 height +\u00a06.2, <jats:italic>R<\/jats:italic><jats:sup>2<\/jats:sup>\u00a0=\u00a00.97. Based on the latter equation, a modified Morgan formula was identified as: <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> position at nares in cm\u00a0=\u00a00.12\u00a0\u00d7\u00a0height\u00a0+\u00a05. If the <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> had been placed as calculated by this formula, the <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> tip would have been at 85\u00a0+\u00a05% (mean\u00a0\u00b1\u00a0<jats:sc>sd<\/jats:sc>) of <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> distance, and the <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> tip\u2010to\u2010carina distance would have been 3.1\u00a0\u00b1\u00a01.1\u00a0cm (range 0\u20136.6). Bronchial intubation would not have occurred in any child, but a comparison to tracheal length measurements indicates that <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> tip position could be too proximal in some children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The study confirms previous reports: <jats:styled-content style=\"fixed-case\">NC<\/jats:styled-content> distance can be well\u00a0predicted from height\/length. A modified Morgan formula might decrease the risk for accidental endobronchial intubation in infants and children,\u00a0but <jats:styled-content style=\"fixed-case\">ETT<\/jats:styled-content> position need to be confirmed by auscultation or other verification.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.12693","type":"journal-article","created":{"date-parts":[[2015,5,30]],"date-time":"2015-05-30T06:14:31Z","timestamp":1432966471000},"page":"936-942","source":"Crossref","is-referenced-by-count":5,"title":["Nares\u2010to\u2010carina distance in children: does a \u2018modified Morgan formula\u2019 give useful guidance during nasal intubation?"],"prefix":"10.1111","volume":"25","author":[{"given":"Agnes I.","family":"Hunyady","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital University of Washington School of Medicine Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randolph K.","family":"Otto","sequence":"additional","affiliation":[{"name":"Department of Radiology Seattle Children's Hospital University of Washington School of Medicine Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexis","family":"Christensen","sequence":"additional","affiliation":[{"name":"Center for Clinical and Translational Research Seattle Children's Hospital Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christer","family":"Jonmarker","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Seattle Children's Hospital University of Washington School of Medicine Seattle WA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,5,29]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.1971.tb00767.x"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03007939"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0b013e3181730288"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-540-92972-7"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02011719"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10278-004-1014-6"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aem350"},{"key":"e_1_2_12_9_1","first-page":"840","article-title":"Dimensions of the growing trachea related to body height. 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