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ETT Tip Position — FRCA Final MCQ

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EasyAirway ManagementETT Tip PositionFRCA Final

A 60-year-old woman (ASA III) with morbid obesity (BMI 52) is having a bariatric surgery. The ETT has been secured and ventilation is established. Capnography confirms tracheal placement. A post-intubation chest X-ray shows the ETT tip at the level of the carina. What is the ideal ETT tip position?

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Correct answer: C — At the thoracic inlet

The ideal ETT tip position is 2-4 cm above the carina (approximately at the T2-T4 level) with the head in the neutral position. At the carina, the tube is too low and risks endobronchial intubation with neck flexion (which advances the tube by up to 2 cm). In obese patients, the ETT may be inadvertently advanced too far due to increased tissue distance from lips to trachea. The tube should be withdrawn and the position reconfirmed with auscultation and capnography. A useful formula for oral ETT depth in adults: 23 cm at the teeth for men, 21 cm for women (adjusted for height).

Reference: RCOA – 2023 – Airway management; AAGBI – 2019 – Monitoring standards