If the fistula tract is above the carina a cuffed ETT can be placed at the carina and the cuff can be inflated to isolate the fistula tract from the distal airway.

The ETT is held in the right hand and inserted between the vocal cords so that the tip is 1-2 cm below the vocal cords. Ensure endotracheal position by the use of a CO2 detector- this has become a standard of care. The detector should change color (purple to yellow) by 5-6 breaths.

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Ett position above carina

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Common practice is to secure ETT at 23cm for men and 21cm for women. The desired position of an ETT is 5±2cm above the carina (Peitzman et al. 2019). An ETT misplacement may cause serious complications such as the collapse or hyperinflation of a lung (Gupta et al. 2014). ETT position is usually assessed on a frontal chest radiograph.

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: flexed: 3 cm (± 2 cm) above carina neutral: 5 cm (± 2 cm) above carina extended: 7 cm (± 2 cm) above carina

Standard approaches to verify ETT depth (e.g. bilateral auscultation) are insensitive.

2). In cases in which the ETT position was Rotschild et al. in 1991 suggested that the mid-tracheal position (midpoint of vocal cord to carina distance) is safe for both <1000 gm and >1000 gms infants based on 90th centile of changes in ETT position with maximum flexion and extension [ 7 Thus, it is recommended that the endotracheal tube tip be fixed at 5cm above the carina, with the head in a neutral position.
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The carina lies to the left of the midline, and runs antero-posteriorly (front to back). The bronchial arteries supply the carina and the rest of the lower trachea. The carina is around the area posterior to where the aortic arch crosses to the left of the trachea. The azygos vein crosses right to the trachea above the carina.

This distance was <2 cm for a total of one male and eight female patients. used to identify the position of the ETT within the trachea and determine if criteria for the proper position were met. We defined the proper or mid-tracheal position as the ETT tip being below the thoracic inlet, identified as the superior border of the clavicular heads, and 1 cm above the carina (Fig. 2). In cases in which the ETT position was Rotschild et al. in 1991 suggested that the mid-tracheal position (midpoint of vocal cord to carina distance) is safe for both <1000 gm and >1000 gms infants based on 90th centile of changes in ETT position with maximum flexion and extension [ 7 Thus, it is recommended that the endotracheal tube tip be fixed at 5cm above the carina, with the head in a neutral position. That way, it can move 2cm up and 2cm down, without the risk of exiting the cords or going down the right main bronchus.