The enduring myth of why a distally placed endotracheal tube always goes into the right mainstem bronchus

2020 ◽  
pp. postgradmedj-2020-139401
Author(s):  
Anthony M-H Ho ◽  
Gregory Klar ◽  
Glenio B Mizubuti
Keyword(s):  
Endotracheal Tube ◽  
Mainstem Bronchus ◽  
The Right

The Esophageal Detector Device: Accuracy and Reliability in Difficult Airway Settings

1996 ◽  
Vol 11 (1) ◽  
pp. 60-62 ◽  
Author(s):  
Christopher E. Kapsner ◽  
David C. Seaberg ◽  
Charles Stengel ◽  
Kaveh Ilkhanipour ◽  
James Menegazzi
Keyword(s):  
Emergency Medicine ◽  
Pulmonary Edema ◽  
Difficult Airway ◽  
Laboratory Investigation ◽  
Respiratory Arrest ◽  
Tube Placement ◽  
Mainstem Bronchus ◽  
Anatomic Location ◽  
The Right ◽  
Attending Physician

AbstractIntroduction:The esophageal detector device (EDD) recently has been found to assess endotracheal (ET) tube placement accurately. This study describes the reliability of the EDD in determining the position of the ET tube in clinical airway situations that are difficult.Methods:This was a prospective, randomized, single-blinded, controlled laboratory investigation. Two airway managers (an emergency-medicine attending physician and a resident) determined ET-tube placement using the EDD in five swine in respiratory arrest. The ET tube was placed in the following clinical airway situations: 1) esophagus; 2) esophagus with 1 liter of air instilled; 3) trachea; 4) trachea with 5 ml/kg water instilled; and 5) right mainstem bronchus. Anatomic location of the tube was verified by thoracotomy of the left side of the chest.Results:There was 100% correlation between the resident and attending physician's use of the EDD. The EDD was 100% accurate in determining tube placement in the esophagus, in the esophagus with 1 liter of air instilled, in the trachea, and in the right mainstem bronchus. The airway managers were only 80% accurate in detecting tracheal intubations when fluid was present.Conclusions:The EDD is an accurate and reliable device for detecting ET-tube placement in most clinical situations. Tube placement in fluid-filled trachea, lungs, or both, which occurs in pulmonary edema and drowning, may not be detected using this device.

scholarly journals Mucosal Changes in the Trachea and Main Bronchi of Newborn Infants after Nasotracheal Intubation

1975 ◽  
Vol 3 (3) ◽  
pp. 209-217 ◽  
Author(s):  
G. C. Fisk ◽  
W. de C. Baker
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Squamous Metaplasia ◽  
Nasotracheal Intubation ◽  
Newborn Infants ◽  
Respiratory Epithelium ◽  
Lower Trachea ◽  
Nasotracheal Tube ◽  
Mucosal Changes ◽  
The Right

Permanent sequelae of nasotracheal intubation are uncommon, but acute ulceration and squamous metaplasia occur. Histological sections from the trachea and main bronchi were examined in 12 infants. A nasotracheal tube had been inserted during the first two weeks of life of these infants and had been in place for more than one week. In four cases the patient died some time (7 to 108 days) after extubation. Similar sections from patients who were not intubated, intubated only for attempted resuscitation, or intubated for several hours were studied for comparison. The sections were classified according to the degree of mucosal loss and metaplasia, and the extent of the lesions was estimated. Squamous change was seen in most sections from all 12 patients with the exception of one who died 57 days after extubation. Some respiratory epithelium was seen in all patients. In the eight patients who died while intubated, the changes were more marked in the right main bronchus than the left in seven, and more marked in the lower trachea than the upper in five. In the two patients intubated for several hours, in addition to mucosal loss, early metaplasia was seen. It is suggested that mucosal loss is replaced by the squamous metaplasia, and that trauma caused by suction catheters in the lower trachea and right main bronchus is more extensive than that due to the endotracheal tube itself.

scholarly journals Misplacement of left-sided double-lumen tubes into the right mainstem bronchus: incidence, risk factors and blind repositioning techniques

2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Jeong-Hwa Seo ◽  
Jun-Yeol Bae ◽  
Hyun Joo Kim ◽  
Deok Man Hong ◽  
Yunseok Jeon ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mainstem Bronchus ◽  
Double Lumen ◽  
Incidence Risk ◽  
The Right

Histopathology of Acquired Subglottic Stenosis

1981 ◽  
Vol 90 (4) ◽  
pp. 335-338 ◽  
Author(s):  
Gabriel F. Tucker ◽  
Leonard Newton ◽  
Robert J. Ruben
Keyword(s):  
Endotracheal Tube ◽  
Horizontal Plane ◽  
Cricoid Cartilage ◽  
Subglottic Stenosis ◽  
Total Occlusion ◽  
History Of ◽  
The Right ◽  
Stenotic Area

The history of a 2,900 g infant who had no stridor at birth and developed subglottic stenosis is presented in detail. The laryngeal lumen, which accepted a 3 mm endotracheal tube at one day of age, diminished to total occlusion at 15 months of age. There was an 8-day intubation and tracheotomy at nine months. At 19 months the patient expired from associated cardiac problems; the larynx was obtained at autopsy and was serially sectioned in the horizontal plane. A series (1mm-Tracer) of 12 sections through the stenotic area is presented. It demonstrates gross distortion of the cricoid cartilage with ossification extending into the right paraglottic larynx.

scholarly journals The Influence of the Univent® Endotracheal Tube on Internal Jugular Vein Cannulation

2005 ◽  
Vol 33 (1) ◽  
pp. 82-86 ◽  
Author(s):  
W. Schummer ◽  
C. Schummer ◽  
R. Frober ◽  
J. Fuchs ◽  
M. Simon ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Endotracheal Tube ◽  
Internal Jugular Vein ◽  
Jugular Vein ◽  
Clinical Investigation ◽  
Lateral Displacement ◽  
Left Internal Jugular Vein ◽  
Jugular Veins ◽  
Cross Sectional ◽  
The Right

This prospective clinical investigation assessed the effect of placement of a Univent® tube on the anatomy of the internal jugular veins and the success of cannulation of the left internal jugular vein. After obtaining informed consent, 48 adult patients were enrolled. Of these, 42 patients were eligible and were divided into two groups: Univent® tube (group U, n=21) and wire enforced endotracheal tube (group C, n=21). The Univent® tube group were having a left thoracotomy. Using horizontal ultrasound scans just above the thyroid gland, the internal jugular vein was visualized and measured before and after Univent® placement. The number of needle passes necessary to cannulate the left internal jugular vein in the two groups was also compared. Univent® tubes were associated with lateral displacement of the right carotid artery and internal jugular vein on the convex side of the Univent® tube, with compression of the right internal jugular vein by the artery, resulting in a kidney-shaped cross-section of the vein. On the left (concave side of the tube), the neck was indented, the sheath of the left carotid artery was displaced medially, and the left internal jugular vein distorted to an ellipse. There was a significant increase in the lateral diameter and a decrease in the cross-sectional area of the left internal jugular vein (t-test, P<0.05). The first attempt at cannulation of the left internal jugular vein failed significantly more often in the Univent® group (13/21 vs 5/21 in group C, Chi-square 6.22, P=0.025). Cannulation of the internal jugular vein before placement of the Univent® tube, or placement with ultrasound guidance is suggested.

scholarly journals Benign gastrobronchial fistula with adenocarcinoma of the right mainstem bronchus

2010 ◽  
Vol 139 (3) ◽  
pp. e37-e39 ◽  
Author(s):  
Simon Turcotte ◽  
Isabelle L. Cayer ◽  
Jean-Luc Laporte ◽  
Pasquale Ferraro ◽  
Jocelyne Martin ◽  
...  
Keyword(s):  
Mainstem Bronchus ◽  
Gastrobronchial Fistula ◽  
The Right

scholarly journals Successful one-lung ventilation by blocking the right intermediate bronchus in a 7-year-old child: a case report

2019 ◽  
Vol 47 (6) ◽  
pp. 2740-2745
Author(s):  
Seung Youp Baek ◽  
Jin Hwan Kim ◽  
Goo Kim ◽  
Jin Ho Choi ◽  
Chang Young Jeong ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Main Bronchus ◽  
Left Lung ◽  
Lung Ventilation ◽  
Surgical Excision ◽  
One Lung Ventilation ◽  
Lower Lung ◽  
Endobronchial Blocker ◽  
Surgical Field ◽  
The Right

A 7-year-old child underwent surgical excision of a benign mesothelioma of the pleura near the right lower lung. Although insertion of a wire-reinforced endotracheal tube through the left main bronchus was attempted for one-lung ventilation to secure the surgical field of view, the attempt failed. Therefore, an endotracheal tube was inserted into the trachea, and an Arndt endobronchial blocker (Cook Medical, Bloomington, IN, USA) was placed in the right intermediate bronchus under bronchoscopic guidance to selectively block the right lower and middle lobes. The surgery was performed while ventilating the right upper lobe and left lung, and no specific intraoperative adverse events occurred.

A controlled trial to investigate whether the orientation of the bevel and angle of approach determine the side of endobronchial intubation in an adult manikin

2019 ◽  
Vol 30 (3) ◽  
pp. 63-68
Author(s):  
SR Dawson ◽  
PM McConaghy ◽  
RC Barr
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Main Bronchus ◽  
Controlled Trial ◽  
Acute Angle ◽  
Common Reason ◽  
Endobronchial Intubation ◽  
High Incidence ◽  
Laryngoscope Blades ◽  
The Right

One of the commonest complications of endotracheal intubation occurs when the tip of the endotracheal tube passes distal to the carina and enters one of the main bronchi. The perioperative practitioner may observe high airway pressures, hypoxia or even pneumothorax. The most common reason given for the high incidence of right endobronchial intubation is that the right main bronchus comes off the trachea at a more acute angle from the midline. We sought, however, to explore two other factors which may explain this phenomenon – the angle of the tube’s bevel and its trajectory of approach. We conducted a prospective controlled trial in which doctors from our department intubated the trachea of an adult manikin in three distinct sets using standard tube, reversed tubes and reversed laryngoscope blades. We found that the angle of the bevel and trajectory of approach determines the side of endobronchial intubation in an adult manikin.

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