Prevention of Unintentional Esophageal Intubation

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 313-313
Author(s):  
W. L. Niccum
Keyword(s):  
Endotracheal Tube ◽  
Young Patients ◽  
Similar Type ◽  
Esophageal Intubation ◽  
Endotracheal Tubes

I read with interest the experience of Stool, Johnson, and Rosenfeld in unintentionally introducing an endotracheal tube into the esophagus.1 I would like to relate that 15 years or so ago we had a similar type of problem with one of my young patients. We have solved the problem of unintentional esophageal intubation in a different and it seems to me a more simple way. Each one of our Foregger endotracheal tubes has on its proximal end approximately 6 in. of #3 black silk looped through a perforation on the tube.

scholarly journals Accuracy of Age-Based Formula to Predict the Size and Depth of Cuffed Oral Preformed Endotracheal Tubes in Children Undergoing Tonsillectomy

2021 ◽  
pp. 014556132098051
Author(s):  
Matula Tareerath ◽  
Peerachatra Mangmeesri
Keyword(s):  
Body Mass Index ◽  
Endotracheal Tube ◽  
Body Mass ◽  
Normal Weight ◽  
Overweight And Obesity ◽  
The Body ◽  
Insertion Depth ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size ◽  
Actual Size

Objectives: To retrospectively investigate the reliability of the age-based formula, year/4 + 3.5 mm in predicting size and year/2 + 12 cm in predicting insertion depth of preformed endotracheal tubes in children and correlate these data with the body mass index. Patients and Methods: Patients were classified into 4 groups according to their nutritional status: thinness, normal weight, overweight, and obesity; we then retrospectively compared the actual size of endotracheal tube and insertion depth to the predicting age-based formula and to the respective bend-to-tip distance of the used preformed tubes. Results: Altogether, 300 patients were included. The actual endotracheal tube size corresponded with the Motoyama formula (64.7%, 90% CI: 60.0-69.1), except for thin patients, where the calculated size was too large (0.5 mm). The insertion depth could be predicted within the range of the bend-to-tip distance and age-based formula in 85.0% (90% CI: 81.3-88.0) of patients. Conclusion: Prediction of the size of cuffed preformed endotracheal tubes using the formula of Motoyama was accurate in most patients, except in thin patients (body mass index < −2 SD). The insertion depth of the tubes was mostly in the range of the age-based-formula to the bend-to-tip distance.

scholarly journals Effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of airway secretions in endotracheal tubes: substudy of a randomized clinical trial

2020 ◽  
Vol 8 (S1) ◽  
Author(s):  
Sophia van der Hoeven ◽  
◽  
Lorenzo Ball ◽  
Federico Constantino ◽  
David M. van Meenen ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Work Of Breathing ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Invasive Ventilation ◽  
Cross Sectional ◽  
Endotracheal Tubes ◽  
On Demand

Abstract Background Accumulated airway secretions in the endotracheal tube increase work of breathing and may favor airway colonization eventually leading to pneumonia. The aim of this preplanned substudy of the ‘Preventive Nebulization of Mucolytic Agents and Bronchodilating Drugs in Intubated and Ventilated Intensive Care Unit Patients trial’ (NEBULAE) was to compare the effect of routine vs on-demand nebulization of acetylcysteine with salbutamol on accumulation of secretions in endotracheal tubes in critically ill patients. Results In this single-center substudy of a national multicenter trial, patients were randomized to a strategy of routine nebulizations of acetylcysteine with salbutamol every 6 h until end of invasive ventilation, or to a strategy with on-demand nebulizations of acetylcysteine or salbutamol applied on strict clinical indications only. The primary endpoint, the maximum reduction in cross-sectional area (CSA) of the endotracheal tube was assessed with high-resolution computed tomography. Endotracheal tubes were collected from 72 patients, 36 from patients randomized to the routine nebulization strategy and 36 of patients randomized to the on-demand nebulization strategy. The maximum cross-sectional area (CSA) of the endotracheal tube was median 12 [6 to 15]% in tubes obtained from patients in the routine nebulization group, not different from median 9 [6 to 14]% in tubes obtained from patients in the on-demand nebulization group (P = 0.33). Conclusion In adult critically ill patients under invasive ventilation, routine nebulization of mucolytics and bronchodilators did not affect accumulation of airway secretions in the endotracheal tube. Trial registration Clinicaltrials.gov Identifier: NCT02159196

scholarly journals Efficacy of Pressure Support in Compensating for Apparatus Work

1993 ◽  
Vol 21 (1) ◽  
pp. 67-71 ◽  
Author(s):  
A. D. Bersten ◽  
A. J. Rutten ◽  
A. E. Vedig
Keyword(s):  
Endotracheal Tube ◽  
Flow Rate ◽  
Pressure Support ◽  
Work Of Breathing ◽  
Inspiratory Flow ◽  
Inspiratory Flow Rate ◽  
Respiratory Muscle Fatigue ◽  
Tube Size ◽  
Endotracheal Tubes ◽  
Endotracheal Tube Size

Breathing through an endotracheal tube, connector, and ventilator demand valve imposes an added load on the respiratory muscles. As respiratory muscle fatigue is thought to be a frequent cause of ventilator dependence, we sought to examine the efficacy of five different ventilators in reducing this imposed work through the application of pressure support ventilation. Using a model of spontaneous breathing, we examined the apparatus work imposed by the Servo 900-C, Puritan Bennett 7200a, Engstrom Erica, Drager EV-A or Hamilton Veolar ventilators, a size 7.0 and 8.0 mm endotracheal tube, and inspiratory flow rates of 40 and 60 l/min. Pressure support of 0, 5, 10, 15, 20 and 30 cm H2O was tested at each experimental condition. Apparatus work was greater with increased inspiratory flow rate and decreased endotracheal tube size, and was lowest for the Servo 900-C and Puritan Bennett 7200a ventilators. Apparatus work fell in a curvilinear fashion when pressure support was applied, with no major difference noted between the five ventilators tested. At an inspiratory flow rate of 40 l/min, a pressure support of 5 and 8 cm H2O compensated for apparatus work through size 8.0 and 7.0 endotracheal tubes and the Servo 900-C and Puritan Bennett 7200a ventilators. However, the maximum negative pressure was greater for the Servo 900-C. The added work of breathing through endotracheal tubes and ventilator demand valves may be compensated for by the application of pressure support. The level of pressure support required depends on inspiratory flow rate, endotracheal tube size, and type of ventilator.

Oscilloscopic Monitoring To Determine Endotracheal Tube Position

PEDIATRICS ◽  
1975 ◽  
Vol 56 (5) ◽  
pp. 824-826
Author(s):  
Michael A. Nelson ◽  
Gerald B. Merenstein
Keyword(s):  
Early Detection ◽  
Endotracheal Tube ◽  
Sine Wave ◽  
Rapid Diagnosis ◽  
Endobronchial Intubation ◽  
Endotracheal Tubes ◽  
Ventilatory Assist ◽  
Tube Position

Observation of oscilloscopic respiratory sine wave with ventilatory assist permits rapid diagnosis and correction of endobronchial intubation. Continuous oscilloscopic monitoring will permit early detection of extubation or malposition of endotracheal tubes.

Endotracheal and Enteric Tubes

Chest Imaging ◽  
2019 ◽  
pp. 35-39
Author(s):  
Tyler H. Ternes
Keyword(s):  
Mechanical Ventilation ◽  
Gas Exchange ◽  
Endotracheal Tube ◽  
Medical Devices ◽  
Esophageal Intubation ◽  
Ideal Position ◽  
Tracheostomy Tubes ◽  
Tube Malposition ◽  
The Ideal

The Endotracheal and Enteric Tubes chapter addresses these frequently used medical devices. An endotracheal tube (ETT) is a catheter placed into the airway for mechanical ventilation. It serves to protect the airway and provide adequate gas exchange. The ideal position of the endotracheal tube tip is approximately 5 cm above the carina. Complications of ETT placement include inadequate ventilation if placed too high or too low, esophageal intubation and tracheal injury. Tracheostomy tubes are used in patients who require long-term intubation. Enteric tubes are thin flexible hollow catheters that course into the stomach and beyond. They may be placed via nasal (nasogastic) or oral (orogastric) approach. When used for suctioning, the ideal position of the tube tip is within the stomach. When used for administration of drugs or nutrition, the tube tip is ideally advanced beyond the pylorus. Enteric tube malposition may be due to coiling within the esophagus or inadvertent malposition within the airway. Malpositioning could result in aspiration, lung injury, and pneumothorax.

scholarly journals A Simple Technique for Diagnosing Oesophageal Intubation

1989 ◽  
Vol 17 (1) ◽  
pp. 39-43 ◽  
Author(s):  
M. Kalpokas ◽  
W. J. Russell
Keyword(s):  
Endotracheal Tube ◽  
Nasogastric Tube ◽  
Simple Technique ◽  
Morbidity And Mortality ◽  
Endotracheal Tubes ◽  
Gastric Contents ◽  
Oesophageal Intubation ◽  
Continuous Suction

Undiagnosed oesophageal intubation during anaesthesia is a major cause of anaesthetic-related morbidity and mortality. A test was devised and evaluated to distinguish between placing an endotracheal tube in the trachea and in the oesophagus. The test involves threading a lubricated nasogastric tube through the endotracheal tube, applying continuous suction to the nasogastric tube and then attempting to withdraw the nasogastric tube. Four aspects distinguish an endotracheal tube in the trachea from one in the oesophagus: 1. the length of nasogastric tube inserted and the feel of the final obstruction to further insertion, 2. the ability to maintain unobstructed suction through the nasogastric tube, 3. the ease of withdrawal of the nasogastric tube during continuous suction, 4. the nature of any aspirate (i.e. mucus or gastric contents). An evaluation was performed on twenty patients in whom both the trachea and oesophagus were intubated simultaneously. In all twenty cases, each of the two endotracheal tubes was correctly identified as being either tracheal or oesophageal. The ability to maintain suction and the ease of withdrawal most clearly distinguished between the two positions.

Cuffed endotracheal tubes in children: the effect of the size of the cuffed endotracheal tube on intracuff pressure

2017 ◽  
Vol 27 (5) ◽  
pp. 494-500 ◽  
Author(s):  
Senthil G. Krishna ◽  
Mumin Hakim ◽  
Roby Sebastian ◽  
Heather L. Dellinger ◽  
Dmitry Tumin ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Intracuff Pressure ◽  
Endotracheal Tubes ◽  
Cuffed Endotracheal Tube

scholarly journals Effectiveness and safety of endotracheal tube cuffs filled with air versus filled with alkalinized lidocaine: a randomized clinical trial

2007 ◽  
Vol 125 (6) ◽  
pp. 322-328 ◽  
Author(s):  
Lais Helena Camacho Navarro ◽  
José Reinaldo Cerqueira Braz ◽  
Giane Nakamura ◽  
Rodrigo Moreira e Lima ◽  
Fredson de Paula e Silva ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Sore Throat ◽  
Cuff Pressure ◽  
Systolic Arterial Pressure ◽  
Tracheal Extubation ◽  
Prospective Clinical Study ◽  
Intracuff Pressure ◽  
Endotracheal Tubes ◽  
Oxide Anesthesia ◽  
De Medicina

CONTEXT AND OBJECTIVE: High intracuff pressure in endotracheal tubes (ETs) may cause tracheal lesions. The aim of this study was to evaluate the effectiveness and safety of endotracheal tube cuffs filled with air or with alkalinized lidocaine. DESIGN AND SETTING: This was a prospective clinical study at the Department of Anesthesiology, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista. METHODS: Among 50 patients, ET cuff pressures were recorded before, 30, 60, 90 and 120 minutes after starting and upon ending nitrous oxide anesthesia. The patients were randomly allocated to two groups: Air, with ET cuff inflated with air to attain a cuff pressure of 20 cmH2O; and Lido, with ET cuff filled with 2% lidocaine plus 8.4% sodium bicarbonate to attain the same pressure. ET discomfort before tracheal extubation, and sore throat, hoarseness and coughing incidence were studied at the time of discharge from the post-anesthesia care unit, and sore throat and hoarseness were studied 24 hours after anesthesia. RESULTS: Pressures in Lido cuffs were significantly lower than in Air cuffs (p < 0.05). Tracheal complaints were similar for the two groups, except for lower ET discomfort and sore throat incidence after 24 hours and lower systolic arterial pressure at the time of extubation in the Lido group (p < 0.05). CONCLUSION: ET cuffs filled with alkalinized lidocaine prevented the occurrence of high cuff pressures during N2O anesthesia and reduced ET discomfort and postoperative sore throat incidence. Thus, alkalinized lidocaine-filled ET cuffs seem to be safer than conventional air-filled ET cuffs.

Teaching Basic EMTs Endotracheal Intubation: Can Basic EMTs Discriminate between Endotracheal and Esophageal Intubation?

1994 ◽  
Vol 9 (4) ◽  
pp. 234-237 ◽  
Author(s):  
Michael R. Sayre ◽  
John Sakles ◽  
Alan Mistler ◽  
Janice Evans ◽  
Anthony Kramer ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Endotracheal Intubation ◽  
Medical Center ◽  
Tube Placement ◽  
Emergency Medical Technicians ◽  
Esophageal Intubation ◽  
Direct Visualization ◽  
Chest Cavity ◽  
Advanced Airway ◽  
Endotracheal Tube Placement

AbstractHypothesis:Advanced airway intervention techniques are being considered for use by basic emergency medical technicians (EMTs). It was hypothesized that basic EMTs would be able to discriminate reliably between intratracheal and esophageal endotracheal tube, placement in a mannequin model.Design:An airway mannequin with a closed chest cavity was intubated randomly either esophageally or tracheally, and the cuff was inflated. A stethoscope, bag ventilator, and laryngoscope were available next to the mannequin. Placement was assessed by auscultation or direct visualization at the discretion of the EMT. A blinded investigator graded the student.Setting:A classroom in a large, urban medical center.Participants:Subjects were basic EMTs who volunteered to take part after the conclusion of a six-hour endotracheal intubation training course.Results:Thirty-three subjects were tested. Seventeen of 18 (94%) tracheal intubations and 11 of 15 (73%) esophageal intubations were identified correctly. Only 72% of the students listened to the epigastrium, 81% listened to the lungs, and 85% attempted ventilation. The 10 students who visualized the cords discovered all five esophageal intubations. The 23 students who did not visualize the cords missed four and found six esophageal intubations.Conclusion:Basic EMTs had difficulty assessing endotracheal tube placement in a mannequin model. The 27% miss rate for identifying esophageal intubations suggests that basic EMTs will require additional training for safe field use of any airway that requires assessment of tube placement.

scholarly journals Delayed recognition of esophageal intubation

CJEM ◽  
2002 ◽  
Vol 4 (01) ◽  
pp. 41-44 ◽  
Author(s):  
Kenneth C. Dittrich
Keyword(s):  
Endotracheal Tube ◽  
Tube Placement ◽  
Esophageal Intubation ◽  
Endotracheal Tube Placement ◽  
Delayed Recognition

ABSTRACTIt is important for clinicians to be aware of the sensitivity and limitations of commonly used methods to confirm endotracheal tube placement. Overreliance on insensitive indicators can lead to delayed recognition of esophageal intubation. The case presented highlights this concern.

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