Reference — Airway Management
Intubation Equipment & Setup
A good intubation is mostly a good setup. This reference collects what the RT lays out before the first attempt — the SOAP-ME checklist, tube sizes and depths across the age range, the laryngoscope blades, and the rescue devices that need to be in the room before, not after, things go sideways.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Preparation is where intubations are won or lost. A missing suction, an untested cuff, or a rescue device left in the supply room turns a routine airway into an emergency. The SOAP-ME mnemonic organizes the equipment check so nothing is forgotten, and the sizing tables keep the right tube and depth at hand. The tables below cover the checklist, tube sizing for adults and children, and the blades and rescue devices to have ready.
The SOAP-ME Checklist
| Letter | Item | Detail |
|---|---|---|
| S | Suction | Yankauer plus suction catheter, tested and within reach |
| O | Oxygen | Preoxygenation source, bag-valve-mask with reservoir, apneic oxygenation via nasal cannula |
| A | Airways | ETTs (planned size and ±0.5), stylet, OPA/NPA, supraglottic backup; patient positioned |
| P | Pharmacy | Induction agent, paralytic, and a vasopressor on hand |
| M | Monitoring | SpO₂, waveform capnography, blood pressure, ECG; laryngoscope checked |
| E | ETT / End-tidal | Cuff integrity checked, 10 mL syringe, end-tidal CO₂ confirmation ready |
ETT Sizing & Depth
| Patient | ETT Size (ID, mm) | Depth at Lips |
|---|---|---|
| Adult female | 7.0–8.0 (often 7.5) | ~21 cm |
| Adult male | 7.5–8.5 (often 8.0) | ~23 cm |
| Child (cuffed) | (age ÷ 4) + 3.5 | ETT size × 3 cm |
| Child (uncuffed) | (age ÷ 4) + 4 | ETT size × 3 cm |
| Term infant | 3.0–3.5 | ~9–10 cm |
Blades & Rescue Devices
| Device | Use |
|---|---|
| Macintosh (curved) | Sits in the vallecula, indirectly lifts the epiglottis; common adult blade |
| Miller (straight) | Directly lifts the epiglottis; pediatrics and the anterior airway |
| Video laryngoscope | Improved glottic view; difficult airway |
| Bougie (introducer) | Rescue when only the posterior glottis is seen |
| Supraglottic airway (LMA) | Rescue for a failed intubation |
Clinical Notes
- Confirm cuff integrity before insertion. Inflate and check the cuff before the tube goes anywhere near the patient — a leak found mid-procedure means starting over with a new tube.
- Pick the tube size and keep ±0.5 ready. Choose the planned size for the patient and have the next size down opened and within reach in case the cords are tighter than expected.
- Inflate to minimal occlusive volume. Add just enough air to stop the leak and confirm a cuff pressure of 20 to 30 cmH₂O — enough to seal and protect against aspiration, not so much that it injures the tracheal mucosa.
- Waveform capnography is mandatory confirmation. Have end-tidal CO₂ ready before the attempt; a sustained waveform is what proves the tube is in the trachea.
- Have a rescue plan ready before the first attempt. A bougie, a supraglottic airway, and a surgical airway option should be staged and accounted for before laryngoscopy begins, not located after a failed pass.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.
- Apfelbaum JL, Hagberg CA, Connis RT, et al. 2022 American Society of Anesthesiologists practice guidelines for management of the difficult airway. Anesthesiology. 2022;136(1):31-81.