Calculate appropriate balloon dilation sizes for airway procedures based on patient age
| Patient Age | Age-Appropriate ETT (uncuffed)* | OD on ETT (mm) | Dilation Goal Diameter - Larynx (mm) | Dilation Goal Diameter - Trachea (mm) |
|---|---|---|---|---|
| Premature < 30 weeks | 2.5mm | 3.6 | - | 5 |
| Premature > 30 weeks | 3.0mm | 4.3 | 5 | 6 |
| Newborn | 3.5mm | 4.9 | 6 | 7 |
| 1 year | 4.0mm | 5.6 | 6 | 7 |
| 2 years | 4.5mm | 6.2 | 7 | 8-8.5 |
| 4 years | 5.0mm | 6.9 | 8-8.5 | 8.5-9 |
| 6 years | 5.5mm | 7.5 | 8-9 | 8.5-10 |
| 8 years | 6.0mm | 8.2 | 8-9 | 10 |
| 10 years | 6.5mm | 8.9 | 10 | 10-12 |
| 12 years | 7.0mm | 9.5 | 10-12 | 12-14 |
| 14 years | 7.5mm | 10.2 | 12 | 12-14 |
| 16 years | 8.0mm | 11.0 | 12 | 14-16 |
| Adult Female | 7.0-8.0mm | - | 12-14mm | 14-16mm |
| Adult Male | 7.5mm-8.5mm | - | 14-16mm | 16-18mm |
* Mallinkrodt oronasal uncuffed endotracheal tubes
Gradual Dilation: Start with smaller balloon sizes and gradually increase to goal diameter to minimize trauma
Anatomical Variations: Individual patient anatomy may require adjustment from guideline recommendations
Stenosis Severity: Degree and location of stenosis should guide balloon selection and inflation pressure
Monitoring: Continuous endoscopic visualization during dilation is essential for safety
Complications: Be prepared to manage potential complications including bleeding, perforation, and airway edema
This is Mike Rutter's highly opinionated personal sizing chart, justified only by clinical experience. Surely one day better will come along!
Enquiries regarding balloon dilation: Mike.Rutter@cchmc.org
Mallinkrodt Medical Inc. Endotracheal Tube Sizing Guidelines. Product specifications for oronasal uncuffed endotracheal tubes.
Hartnick CJ, Hartley BE, Lacy PD, et al. Surgery for pediatric subglottic stenosis: disease-specific outcomes. Ann Otol Rhinol Laryngol. 2001;110(12):1109-1113.
Whigham AS, Howell R, Choi S, et al. Outcomes of balloon dilation in pediatric subglottic stenosis. Ann Otol Rhinol Laryngol. 2012;121(7):442-448.
Lang M, Brietzke SE. A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis. Otolaryngol Head Neck Surg. 2014;150(2):174-179.