Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions

Abstract Study Objective To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Design Prospective crossover study. Setting University-affiliated hospital. Patients 44 adult, ASA physical status 1, 2, and 3 patients undergoing open...

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Bibliographic Details
Published in:Journal of clinical anesthesia 2011-08, Vol.23 (5), p.367-371
Main Authors: Rigini, Nugzar, MD, Boaz, Mona, PhD, Ezri, Tiberiu, MD, Evron, Shmuel, MD, Trigub, Dimitry, MD, Jackobashvilli, Simon, MD, Izakson, Alexander, MD
Format: Article
Language:English
Subjects:
Abdomen
Abdomen - surgery
Adult
Aged
Anesthesia
Anesthesia & Perioperative Care
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Auscultation
Biological and medical sciences
Bronchoscopy - methods
Chest auscultation
Cross-Over Studies
Device Removal
Endotracheal tube
Female
Fiber Optic Technology
Fiberoptic bronchoscopy
Head
Hospitals, University
Humans
Inappropriate positioning
Intubation
Intubation, Intratracheal - methods
Laparoscopy - methods
Male
Medical sciences
Methods
Middle Aged
Pain Medicine
Prospective Studies
Radiography
Surgery
Surgical Procedures, Operative - methods
Time Factors
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Summary:Abstract Study Objective To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Design Prospective crossover study. Setting University-affiliated hospital. Patients 44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures. Interventions ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement. Measurements The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning. Main Results FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation ( P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation ( P = 0.24). There were 15 other "out-of-desired range” positions (out of the 3-5 cm range) – one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women ( P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery. Conclusions Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions.
ISSN:0952-8180
1873-4529
DOI:10.1016/j.jclinane.2010.11.002