To evaluate the accuracy of the Advanced Pediatric Life Support (APLS) endotracheal tube (ET) depth formula in Indian children aged 1 to 12 years.

We enrolled 86 children aged 1–12 years requiring intubation and ventilation. The ET depth was determined using the APLS formula, and chest X-rays were utilized to evaluate ‘appropriate ET depth (accuracy)’ based on ‘vertebral level criteria’ and ‘safe distance between ET tip and carina.’

Out of 86 cases, none had bronchial intubation. An accuracy of 37.2% (32 cases) was observed, with 57% (49 cases) showing deep placement. Among deep placements, 11 met ‘vertebral level criteria’ but not ‘safe distance criteria.’ Redefining deep placement based solely on ‘safe distance criteria,’ resulted in 50% accuracy.

APLS formula effectively prevents bronchial intubation in Indian children, but tends to overestimate ET depth (50% cases) when considering the ‘safe distance between ET tip and carina.’