2026 Annual Meeting, presented by IARS and SOCCA

Just as adults, children of all ages have a less acute angle between the right mainstem bronchus and the trachea. For this reason, an endotracheal tube (ETT) is more likely to be malpositioned into the right mainstem bronchus with maneuvers of the head and body, such as Trendelenburg position. The length of the trachea is shorter in a child at age 18 months (7-8 cm) compared to an adult (10-11cm) making right mainstem bronchial intubation even more likely in young children. Alveoli take up to age 8 years to fully develop, and because of the immature alveoli, pulmonary reserve is lower in children. Thus, the signs of decreased ventilation of the left lung (hypoxia, hypercapnia) are apparent sooner than in adults. Laryngospasm occurs without an endotracheal tube in place, thus it is unlikely to occur in a patient who is intubated. Bronchospasm could lead to oxygen desaturation and hypercarbia. Appropriate uncuffed ETT sizes for children = age/4 + 4. Given that this child’s age is 1.5 years old, it is appropriate to use an uncuffed ETT size 4.