The Role of Carbon Dioxide Detectors for Confirmation of Endotracheal Tube Position

AbstractThis study compares the performance of two commercially available devices (Ambu. TubeChek™ and SCOTI™ in establishing endotracheal (ET) tube position (oesophageal vs. tracheal) in a mannequin and in miniature pigs. The Ambu TubeChek is a syringe-type, Oesophageal Detector Device (ODD) that fits to the endotracheal tube connector. Air is aspirated easily from the rigid trachea, but not from the collapsing esophagus. The Sonomatic Confirmation of Tracheal Intubation device (SCOTI) is a lightweight battery-powered, sonomatic device. It emits sound waves into the tube and analyzes the reflection. The SCOTI purports to enable a user-independent and carbon-dioxide-independent assessment of tube position following intubation.Intubation followed by tube position assessment with Ambu TubeChek (ODD) was significantly faster and easier with the ODD than with the SCOTI. The SCOTI cannot differentiate tracheal from oesophageal ET-tube position in mini-pigs.In situations in which capnometry is not available or the CO2 production and transport are compromised (CPR), we recommend the use of an Oesophageal Detector Device (ODD) rather than the SOCTI.

Download Full-text

Validity of a disposable end-tidal carbon dioxide detector in verifying endotracheal tube position in piglets

Journal of Emergency Medicine ◽

10.1016/0736-4679(91)90255-e ◽

1991 ◽

Vol 9 (6) ◽

pp. 530-531

Author(s):

Leslie Milne

Keyword(s):

Carbon Dioxide ◽

Endotracheal Tube ◽

End Tidal Carbon Dioxide ◽

Tube Position ◽

End Tidal

Download Full-text

Validity of a disposable end-tidal carbon dioxide detector in verifying endotracheal tube position in piglets

Critical Care Medicine ◽

10.1097/00003246-199104000-00020 ◽

1991 ◽

Vol 19 (4) ◽

pp. 566-568 ◽

Cited By ~ 12

Author(s):

MANANDA S. BHENDE ◽

ANN E. THOMPSON ◽

DONNA F. HOWLAND

Keyword(s):

Carbon Dioxide ◽

Endotracheal Tube ◽

End Tidal Carbon Dioxide ◽

Tube Position ◽

End Tidal

Download Full-text

Carbon Monoxide and Nonquantitative Carbon Dioxide Detection

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00043120 ◽

1996 ◽

Vol 11 (4) ◽

pp. 276-279 ◽

Cited By ~ 2

Author(s):

Georg Petroianu ◽

Wolfgang Maleck ◽

Wolfgang Bergler ◽

Roderich Ruefer

Keyword(s):

Carbon Dioxide ◽

Carbon Monoxide ◽

Endotracheal Tube ◽

Reliable Method ◽

Hospital Setting ◽

Infrared Spectrometry ◽

End Tidal Carbon Dioxide ◽

Tube Position ◽

Carbon Dioxide Detection ◽

End Tidal

AbstractIntroduction:The capnometric demonstration of end-tidal carbon dioxide (CO2) is a reliable method of differentiating between a correct endotracheal tube position and an accidental misplacement of the tube into the esophagus. Recently, several CO2 detectors have been introduced for monitoring end-tidal CO2 in the “out-of-hospital” setting, where quantitative capnometry with capnography is not yet available.Hypothesis:These devices are not influenced by carbon monoxide (CO) present in lethal concentration.Methods:A heated (37°C) 2.3 L reservoir bag filled one-third full with water (representing the stomach in esophageal misintubation) was machine ventilated (tidal volume: 450 ml; frequency: 16/min) with the following mixtures for three minutes each: 1) 95% O2, 5% CO; 2) 45% O2 5% CO, 50% N2O; and 3) 44% O2 5% CO, 50% N2O, 1% halothane. The presence of end-tidal CO2 was monitored with each of the following devices: 1) MiniCAP™ III CO2 Detector; 2) StatCAP™ CO2 Detector; 3) EasyCAP™ CO2 Detector; PediCAP™ CO2 Detector; and 5) Colibri™ CO2 Detector.Results:In none of the cases was the presence of CO2 signaled by the detector.Conclusion:The presence of 5% CO does not interfere with infrared spectrometry detection (MiniCAP™ and StatCAP™) or chemical detection (EasyCAP™, PediCAP™, and Colibri™) of CO2. The devices can be used safely in patients with CO poisoning for monitoring of endotracheal tube position.

Download Full-text

Accuracy and Reliability of the Self-inflating Bulb to Verify Tracheal Intubation in Out-of-hospital Cardiac Arrest Patients

Anesthesiology ◽

10.1097/00000542-200012000-00015 ◽

2000 ◽

Vol 93 (6) ◽

pp. 1432-1436 ◽

Cited By ~ 42

Author(s):

Koichi Tanigawa ◽

Taku Takeda ◽

Eiichi Goto ◽

Keiichi Tanaka

Keyword(s):

Carbon Dioxide ◽

Cardiac Arrest ◽

Tracheal Intubation ◽

Endotracheal Tube ◽

Clinical Judgment ◽

False Negative ◽

The Self ◽

Tube Position ◽

Hospital Cardiac Arrest ◽

Observation Period

Background To determine the sensitivity and specificity of the self-inflating bulb (SIB) to verify tracheal intubation in out-of-hospital cardiac arrest patients. Methods Sixty-five consecutive adult patients with out-of-hospital cardiac arrest were enrolled. Patients were provided chest compression and ventilation by either ba-valve-mask or the esophageal tracheal double-lumen airway by ambulance crews when they arrived at the authors' department. Immediately after intubation in the emergency department, the endotracheal tube position was tested by the SIB and end-tidal carbon dioxide (ETCO2) monitor using an infrared carbon dioxide analyzer. We observed the SIB reinflating for 10 s, and full reinflation within 4 s was defined as a positive result (tracheal intubation). Results Five esophageal intubations occurred, and the SIB correctly identified all esophageal intubations. Of the 65 tracheal intubations, the SIB correctly identified 47 tubes placed in the trachea (72.3%). Delayed but full reinflation occurred in one tracheal intubation during the 10-s observation period. Fifteen tracheal intubations had incomplete reinflation during the observation period, and two tracheal intubations did not achieve any reinflation. Thirty-nine tracheal intubations were identified by ETCO2 (60%). When the SIB test is combined with the ETCO2 detection, 59 tracheal intubations were identified with a 90.8% sensitivity. Conclusions The authors found a high incidence of false-negative results of the SIB in out-of-hospital cardiac arrest patients. Because no single test for verifying endotracheal tube position is reliable, all available modalities should be tested and used in conjunction with proper clinical judgment to verify tracheal intubation in cases of out-of-hospital cardiac arrest.

Download Full-text