Upright (45°) Versus Supine Position for Intubation in Intracranial Bleed Patients

Objective: To find out the effective method of endotracheal intubation among patients of intracranial bleed. Methods: A quasi experimental research was performed at emergency department of Ziauddin University Hospital Karachi. 236 intracranial bleed patients were selected by consecutive sampling, half of them were intubated at upright position (45°) and remaining half at supine position. Patients of musculoskeletal deformities, ischemic stroke and previously intubated were excluded. Success or failure of endotracheal tube was confirmed by measuring oxygen saturation and audible breath sounds on chest. Results: Success rate of endotracheal placement (p-value <0.001) was high in upright position 115 (97.5%) as compared to supine position 90 (76.3%). Similarly, endotracheal tube placement attempts (p-value <0.001) and completion time (p-value <0.001) was low in upright position 1.1 ± 0.4 and 62.9 ± 24.9 sec as compared to supine position 1.5 ± 0.9 and 90.2 ± 67.9 sec. Conclusion: Endotracheal intubation of intracranial bleed patient at upright position is more successful, effective, less painful in terms of number of attempts and less time consuming as compared to supine position.

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

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00041467 ◽

1994 ◽

Vol 9 (4) ◽

pp. 234-237 ◽

Cited By ~ 8

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.

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Chula Formula sebagai Prediktor Ketepatan Kedalaman Endotracheal Tube pada Intubasi Nasotracheal

Jurnal Anestesi Perioperatif ◽

10.15851/jap.v7n1.1491 ◽

2019 ◽

Vol 7 (1) ◽

pp. 42-47

Author(s):

Akhmad Rhesa Sandy ◽

Indriasari Indriasari ◽

Ruli Herman Sitanggang

Keyword(s):

Endotracheal Tube ◽

Analytical Study ◽

Nasotracheal Intubation ◽

Tube Placement ◽

P Value ◽

Main Concern ◽

Fiberoptic Bronchoscope ◽

Research Subjects ◽

Endotracheal Tube Placement ◽

The Ideal

Intubasi nasotrakeal adalah salah satu metode yang umum digunakan pada operasi intraoral dan maksilofasial yang memiliki keunggulan untuk menyediakan akses yang lebih baik. Hal yang menjadi perhatian utama ketika memasukkan endotracheal tube (ETT) adalah penempatan yang tepat dan sesuai sehingga menghindari komplikasi akibat malposisi ETT. Fiberoptic bronchoscope (FOB) adalah cara yang paling pasti untuk menilai penempatan ujung ETT karena menyediakan visualisasi secara langsung sehingga dapat mengukur penempatan ETT yang ideal, tetapi FOB tidak selalu tersedia di rumah sakit. Penelitian ini bermaksud menilai kesesuaian Chula formula, yaitu rumus yang menggunakan tinggi badan untuk menempatkan ETT pada posisi yang tepat. Penelitian ini merupakan penelitian analitik yang dilakukan secara prospektif pada 59 subjek penelitian di RSUP Dr. Hasan Sadikin Bandung pada bulan Juli sampai Agustus 2018. Subjek diintubasi nasotrakeal dengan kedalaman ETT dihitung menggunakan Chula formula, kemudian jarak ujung ETT ke carina dinilai menggunakan FOB. Hasil uji statistik dengan Guilford dan Spearman didapatkan nilai r 0,933 dan p 0,0001 yang menunjukkan kesesuaian yang sangat kuat pada Chula formula untuk menempatkan ETT pada kedalaman yang tepat. Simpulan, Chula formula dapat memprediksi kedalaman ETT dengan tepat pada intubasi nasotrakeal.Chula Formula as a Predictor for Correct Endotracheal Tube Placement for Nasotracheal IntubationNasotracheal intubation is a common method which provides better access for intraoral and maxillofacial operations. The main concern when inserting an endotracheal tube (ETT) is the correct and appropriate placement as there are many complications develop due to ETT malposition. A Fiberoptic Bronchoscope (FOB) is the best way to assess the placement of the tip of the ETT for it provides a direct visualization to measure the ideal ETT placement; however, it is not always readily available in hospitals. This study aims to assess the compatibility of Chula formula, a formula that utilizes height to determine the correct ETT placement. This study was a prospective analytical study on 59 research subjects in Dr. Hasan Sadikin General Hospital Bandung from July to August 2018. The subjects were nasotracheally intubated with the ETT depth measured using the Chula formula, afterwards the distance from the tip of the ETT to the carina was assessed using an FOB. The results from Guilford and Spearman’s were an r value of 0.933 and a p value of 0.0001, showing a statistically significant conformation of the Chula formula in correct ETT placement. It is concluded that Chula formula can be used as a predictor for correct ETT placement in nasotracheal intubation.

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Pilot Study to Evaluate the Accuracy of Ultrasonography in Confirming Endotracheal Tube Placement

Ultrasound Quarterly ◽

10.1097/01.ruq.0000263829.79992.e5 ◽

2007 ◽

Vol 23 (1) ◽

pp. 43

Author(s):

&NA;

Keyword(s):

Pilot Study ◽

Endotracheal Tube ◽

Tube Placement ◽

Endotracheal Tube Placement

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Assessment of gas flow waves for endotracheal tube placement in an ovine model of neonatal resuscitation

Resuscitation ◽

10.1016/j.resuscitation.2010.02.018 ◽

2010 ◽

Vol 81 (6) ◽

pp. 737-741 ◽

Cited By ~ 13

Author(s):

G.M. Schmölzer ◽

S.B. Hooper ◽

K.J. Crossley ◽

B.J. Allison ◽

C.J. Morley ◽

...

Keyword(s):

Endotracheal Tube ◽

Gas Flow ◽

Neonatal Resuscitation ◽

Tube Placement ◽

Ovine Model ◽

Endotracheal Tube Placement

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THE SENSITIVITY, SPECIFICITY AND ACCURACY OF STATIC METHOD OF ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL INTUBATION IN EMERGENCY DEPARTMENT.

10.36106/ijsr/6729269 ◽

2021 ◽

pp. 8-13

Author(s):

Pankaj Kumar Singh ◽

Budhaditya Sanyal ◽

Mohit Bhatnagar ◽

Mandeep Joshi ◽

Shreya Verma

Keyword(s):

Diagnostic Accuracy ◽

Endotracheal Tube ◽

Predictive Value ◽

Static Method ◽

Tube Placement ◽

Short Course ◽

Endotracheal Tube Placement ◽

Linear Probe ◽

Post Intubation ◽

Sensitivity Specificity

Aims and objectives: This study aims to assess the diagnostic accuracy and timeliness of ultrasonography by static method only for identication of Endotracheal tube (ET Tube) placement in the trachea in emergency settings vs existing clinical methods. Material and Methods: This prospective study was carried out in the emergency room from October 2018 till the end of March 2019. The ultrasonography was performed in 120 emergency patients only after the intubation had been completed ie, static phase. A linear probe was used over the neck to identify the predened signs of ET intubation. Residents who perform ultrasound examination ll a form after assessment of each patient. Results: It was found that Tracheal Intubation-USG Sensitivity was 99.1, Specicity was 91.7, Positive Predictive Value: 99.1, Negative Predictive Value was 91.7 and Accuracy was 98.3%. Ultrasonography can be used as an adjunct tool to verify the ETTposition by Emergency Physicians which can be performed easily after a brieng or short-course training.Conclusion:This study demonstrates that US imaging has a high diagnostic accuracy to immediately conrm proper ETT placement post-intubation in an emergency setup. Therefore, it seems that ultrasonography using a static technique only is a proper screening tool in determining endotracheal tube placement.

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Pulmonary atelectasis in newborns with clinically treatable diseases who are on mechanical ventilation: clinical and radiological aspects

Radiologia Brasileira ◽

10.1590/0100-3984.2016.0157 ◽

2018 ◽

Vol 51 (1) ◽

pp. 20-25 ◽

Cited By ~ 2

Author(s):

Mariana Chiaradia Dominguez ◽

Beatriz Regina Alvares

Keyword(s):

Mechanical Ventilation ◽

Endotracheal Tube ◽

Left Lung ◽

Hyaline Membrane Disease ◽

Relevant Information ◽

Tube Placement ◽

Cross Sectional ◽

Pulmonary Atelectasis ◽

Radiology Reports ◽

Endotracheal Tube Placement

Abstract Objective: To analyze the radiological aspects of pulmonary atelectasis in newborns on mechanical ventilation and treated in an intensive care unit, associating the characteristics of atelectasis with the positioning of the head and endotracheal tube seen on the chest X-ray, as well as with the clinical variables. Materials and Methods: This was a retrospective cross-sectional study of 60 newborns treated between 1985 and 2015. Data were collected from medical records and radiology reports. To identify associations between variables, we used Fisher's exact test. The level of significance was set at p < 0.05. Results: The clinical characteristics associated with improper positioning of the endotracheal tube were prematurity and a birth weight of less than 1000 g. Among the newborns evaluated, the most common comorbidity was hyaline membrane disease. Atelectasis was seen most frequently in the right upper lobe, although cases of total atelectasis were more common in the left lung. Malpositioning of the head showed a trend toward an association with atelectasis in the left upper lobe. Conclusion: Pulmonary atelectasis is a common complication in newborns on mechanical ventilation. Radiological evaluation of the endotracheal tube placement provides relevant information for the early correction of this condition.

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