Case report: Vibration response imaging findings following inadvertent esophageal intubation

Abstract

Purpose:We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI). Clinical features:Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally. Conclusion: This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation. Éléments cliniques : L'imagerie par réponse vibratoire (VRI) est une nouvelle technologie informatique non invasive qui mesure l'énergie de vibration des sons pulmonaires pendant la respiration et affiche l'intensité régionale en format visuel et graphique. Les images de réponse vibratoire obtenues avant l'intubation trachéale (respiration spontanée) et pendant la ventilation endotrachéale à l'aide d'un mode contrôlé ont eu pour résultat des vibrations uni-

Early detection of deteriorating ventilation by monitoring bilateral chest wall dynamics in the rabbit

“…Simultaneous auscultation at multiple sites by large arrays of sensors over the chest has been suggested as a method for creating three-dimensional images of air flow through the lungs [18]. However, the use of large arrays of microphones for prolonged monitoring is cumbersome and inconvenient in the NICU setting.…”

Changes in regional distribution of lung sounds as a function of positive end-expiratory pressure

“…Waitman and colleagues classified breath sounds recorded in an intensive care setting using different neural network configurations [ 22 ], and a computerized respiratory sound monitor was used to detect wheezes in pediatric ICU [ 23 ]. Detection of endobronchial [ 24 - 26 ] and esophageal [ 27 ] intubation using lung sound monitoring during anesthesia was also described. Dellinger and colleagues recently reported the use of an acoustic-based imaging device to map the geographical distribution of breath sound as a function of mechanical ventilation mode [ 28 ].…”

Perspectives in respiratory monitoring

“…L'IRV pourrait aider à différencier les pathologies respiratoires obstructives ou non lors des dyspnées aiguës au service d'urgence [37]. Cette technique a aussi été utilisée pour comparer différents modes ventilatoires [38] ou détecter l'intubation oesophagienne involontaire [39].…”