Flexion test for confirmation of tracheal tube placement in paediatrics (original) (raw)
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The assessment of three methods to verify tracheal tube placement in the emergency setting
Resuscitation, 2003
We studied prospectively the reliability of clinical methods, end-tidal carbon dioxide (ETCO 2 ) detection, and the esophageal detector device (EDD) for verifying tracheal intubation in 137 adult patients in the emergency department. Immediately after intubation, the tracheal tube position was tested by the EDD and ETCO 2 monitor, followed by auscultation of the chest. The views obtained at laryngoscopy were classified according to the Cormack grade. Of the 13 esophageal intubations that occurred, one falsepositive result occurred in the EDD test and auscultation. In the non-cardiac arrest patients (n 0/56), auscultation, the ETCO 2 , and EDD test correctly identified 89.3, 98.2*, and 94.6%* of tracheal intubations, respectively (*, P B/0.05 vs. the cardiac arrest patients). In the cardiac arrest patients (n 0/81), auscultation, the ETCO 2 , and the EDD tests correctly identified 92.6**, 67.9, and 75.3% of tracheal intubations, respectively (**, P B/0.05 vs. EDD and ETCO 2 ). The frequencies of Cormack grade 1 or 2 were 83.9% in the non-cardiac arrest, and 95.1% in the cardiac arrest patients. In conclusion, the ETCO 2 monitor is the most reliable method for verifying tracheal intubation in non-cardiac arrest patients. During cardiac arrest and cardiopulmonary resuscitation, however, negative results by the ETCO 2 or the EDD are not uncommon, and clinical methods are superior to the use of these devices. # Palavras chave: Abordagem da via aérea; Aparelho de detecção esofágica; Dió xido de Carbono no fim da expiração; Entubação traqueal; Departamento de emergência * Corresponding author. Tel.: '/91-82-257-5585. Resuscitation 56 (2003) 153 Á/157 www.elsevier.com/locate/resuscitation 0300-9572/02/$ -see front matter # 2002 Elsevier Science Ireland Ltd. All rights reserved. PII: S 0 3 0 0 -9 5 7 2 ( 0 2 ) 0 0 3 4 5 -3
Tracheoscopy with the rapiscope to verify endotracheal tube placement
Journal of Clinical Anesthesia, 2003
Study Objective: To determine whether tracheoscopy is an accurate and quick method for verifying correct placement of the tracheal tube after intubation. Design: Prospective, randomized study. Setting: Operating rooms of a teaching hospital. Patients: 26 patients scheduled for surgery and general anesthesia. Interventions: 8.0-mm tracheal tubes were inserted into both the trachea and the esophagus. Tracheoscopy was performed consecutively through both tracheal tubes by a variety of clinicians. Measurements: The times taken to correctly identify the trachea and the esophagus were recorded. Main Results: Correct identification of either the esophagus or the trachea occurred with a 100% sensitivity and a 96% specificity. The mean time to recognize either the trachea or the esophagus was 22.0 seconds. Conclusions: Tracheoscopy is a reliable method for quickly verifying proper endotracheal placement of a tracheal tube.
Zhonghua yi xue za zhi = Chinese medical journal; Free China ed, 2002
Correct tracheal intubation in critically ill patient is very important in intensive care medicine. The purpose of this study is to evaluate the value and accuracy of the flexible fiberoptic bronchoscopy (FFB) in confirming the endotracheal tube (ETT) position and to compare with the chest radiograph method in intubated pediatric and neonate patients. We prospectively used the FFB to evaluate the ETT position in the pediatric and neonate intensive care units (ICUs) from January 2000 to December 2000. The distance between the ETT tip and the trachea carina measured by FFB (TC-FFB) was recorded and compared with that by the chest radiograph (TC-CR). The consuming time needed for checking the ETT position was also compared between these two methods. There were 74 cases enrolled. There was a significant correlation between TC-FFB and TC-CR (r = 0.898, p = 0.000). It took less time to confirm the ETT position by using the FFB than by the post-intubation chest radiograph (0.3 +/- 0.1 min ...
An assessment of a tracheal tube introducer as an endotracheal tube placement confirmation device
The American Journal of Emergency Medicine, 2005
Introduction: Early detection of an inadvertent esophageal intubation can be particularly challenging in cases when the current standard of care, carbon dioxide detection, is unreliable. We sought to determine the sensitivity and specificity of an inexpensive and portable device, the gum elastic bougie (Eschmann Tracheal Tube Introducer, SIMS Portex, Inc, Keene, NH), as an endotracheal tube placement confirmation device. Methods: We conducted a prospective blinded trial in 20 human cadavers. Each cadaver was randomized to a mixed series of 5 esophageal and 5 tracheal intubations. Each intubation was assessed with the bougie twice, once by a novice to the technique, and once by an assessor who was constant through the trial. Assessors used the bougie to bfeelQ for bclicksQ of the tracheal rings and to appreciate bhang upQ of the bougie as it was advanced into the smaller airways. Absence of these findings was presumed to indicate an esophageal intubation. Actual placement was confirmed by bronchoscopy. Each assessor made an independent determination of tube location. Descriptive statistics were used to summarize the data. Results: Overall, 93% (95% confidence interval [CI], 86%-97%) of tracheal placements were correctly identified. The constant assessor was able to correctly identify 98% (95% CI, 90%-100%). Tracheal rings were detected in 92% of tracheal placements. Ring clicks were 95% specific for tracheal intubation. Hang up was reported in 100% of tracheal placements with a specificity of 84%. Overall, 95% (95% CI, 88%-98%) of esophageal intubations were detected. The constant assessor detected 100% of esophageal intubations. Conclusion: In the cadaver model used in this study, the gum elastic bougie (Eschmann Tracheal Tube Introducer) shows promise as an endotracheal tube confirmation device. D