Correct Endotracheal Tube Placement Using Topographical Landmarks


Rajiv Gandhi Cancer Institute & Research Center, India


Not yet enrolling


Intubation, Intratracheal
Anatomic Landmarks


Device: Intubation guide mark technique of endotracheal tube placement
Device: Topographical landmark technique of endotracheal tube placement

Study type


Funder types




Details and patient eligibility


An optimal endotracheal tube depth is ideally required for preventing the complications associated with mal-positioning of the endotracheal tube. The topographical technique of tube placement considering the individual's morphometric dimensions could help to provide optimal tube placement. hence, to evaluate the efficacy of the topographical technique in providing the optimal tube placement this study will be conducted.

Full description

The trachea is a dynamic organ and its length varies by various static and dynamic factors leading to changing the tracheal length and variable endotracheal tube tip to carina (Ti-Ca) distance. Hence, upholding optimal Ti-Ca distance during changing tracheal length is of utmost importance to prevent complications associated with endotracheal tube (ETT) mal-positioning. When the length of ETT, which is to be inserted inside the trachea, is calculated as per an individual's tracheal morphometric dimensions, the appropriate depth of placement could be achieved and tube malpositioning can be prevented. In the topographical landmark technique, an individual tracheal length is estimated by measuring the various distance from mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane. After estimating the tracheal length, tip to carina distance of 3cm was deducted from the estimated length of the trachea to provide the distance of the endotracheal tube to be kept beyond the vocal cords. Hence, the investigators planned this study to find the "utility and reliability" of the topographical landmark technique compared to the conventional intubation guide mark technique in providing the appropriate depth of endotracheal tube placement.


400 estimated patients




18 to 75 years old


No Healthy Volunteers

Inclusion criteria

• Age group of 18-75 years

  • ASA physical status I-III patients
  • Oral intubation for general anesthesia

Exclusion criteria

• Patient with upper airway fibrosis

  • Tracheal stenosis or tracheal surgeries
  • Previous head and neck surgeries
  • Contracture neck or irradiated neck
  • Large neck swelling distorting or deviating the trachea
  • Laryngeal or tracheal tumor
  • Intubations requiring flexo-metallic tubes
  • Patient refusal

Trial design

Primary purpose




Interventional model

Parallel Assignment


Double Blind

400 participants in 2 patient groups

Topographical landmark technique
Experimental group
Surface anatomic landmarks of an individual's trachea will be measured from the mid-thyroid level (corresponds to vocal cords) to manubriosternal joint (corresponds to carina) in the sagittal plane to estimate tracheal length. Three centimeters will be deducted from the estimated tracheal length to provide the length of the endotracheal tube from the tube tip to be inserted inside the trachea.
Device: Topographical landmark technique of endotracheal tube placement
Intubation guide mark technique
Active Comparator group
Already established and commonly practiced technique, in this technique, the guide mark present above the proximal end of the endotracheal tube cuff will be placed just beyond the vocal cords.
Device: Intubation guide mark technique of endotracheal tube placement

Trial contacts and locations



Central trial contact

Anil K Patel, DNB; Amit K Mittal, M.D

Data sourced from

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