Where should the endotracheal tube ideally be placed?

The ideal placement of the endotracheal tube is 2-3 cm above the carina. This positioning ensures that the tube is appropriately positioned within the trachea, allowing for optimal ventilation while minimizing the risk of accidental extubation or placement in a bronchus. The carina is the bifurcation point where the trachea splits into the left and right mainstem bronchi; placing the tube just above this structure ensures that both lungs receive adequate airflow during mechanical ventilation.

Placing the tube at the vocal cords would not allow for effective ventilation and could potentially lead to complications such as unintentional extubation. Positioning it at the thoracic inlet may increase the risk of the tube being displaced or obstructed. Similarly, placing the tube 10-12 cm below the vocal cords could lead to the tip of the tube being too far down, risking blockage of one of the mainstem bronchi or causing trauma to the lung tissue. Thus, the positioning above the carina is crucial for the safety and efficacy of airway management.