Clinical test to confirm tracheal intubation: a new method to confirm endotracheal intubation in the absence of capnography

Baigel, G.; Safranski, J.

doi:10.1097/00003643-200306000-00009

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…We found only one study reporting on chest movement, in a non‐human model [58]. Twenty‐two studies used a form of capnography as the reference standard [23, 27, 29, 30, 33, 34, 36, 37, 42, 47, 50‐57, 64–66] and three used bronchoscopy [20, 26, 39]. Ten studies, all conducted before 1996, relied solely on direct vision at the time of laryngoscopy or a combination of clinical signs alone [18, 22, 25, 28, 32, 40, 41, 44, 60, 63], whereas another 10 studies did not clearly report the reference standard [18, 19, 21, 31, 35, 46, 60–63].…”

Section: Resultsmentioning

confidence: 99%

“…Devices were tested in the operating theatre setting in 25 studies [18, 19, 22, 25, 27, 28, 31–33, 35, 39, 42, 47–51, 56, 57, 59, 60, 62, 63, 65, 66]; prehospital in ten studies [21, 23, 29, 30, 34, 36, 41, 45, 55, 64]; seven studies in the Emergency Department [23, 36, 37, 44, 52–54]; and three in the ICU [3, 37, 52]. Seven studies were conducted in a laboratory setting [20, 24, 26, 38, 40, 46, 58], and it was not possible to ascertain the setting of one study [61].…”

Section: Resultsmentioning

confidence: 99%

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Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis

et al. 2023

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Unrecognised oesophageal intubation causes preventable serious harm to patients undergoing tracheal intubation. When capnography is unavailable or doubted, clinicians still use clinical findings to confirm tracheal intubation, or exclude oesophageal intubation, and false reassurance from clinical examination is a recurring theme in fatal cases of unrecognised oesophageal intubation. We conducted a systematic review and metaanalysis of the diagnostic accuracy of five clinical examination tests and the oesophageal detector device when used to confirm tracheal intubation. We searched four databases for studies reporting index clinical tests against a reference standard, from inception to 28 February 2023. We included 49 studies involving 10,654 participants. Methodological quality was overall moderate to high. We looked at misting (three studies, 115 participants); lung auscultation (three studies, 217 participants); combined lung and epigastric auscultation (four studies, 506 participants); the oesophageal detector device (25 studies, 3024 participants); `hang-up´(two non-human studies); and chest rise (one non-human study). The reference standards used were capnography (22 studies); direct vision (10 studies); and bronchoscopy (three studies). When used to confirm tracheal intubation, misting has a false positive rate (95%CI) of 0.69 (0.43-0.87); lung auscultation 0.14 (0.08-0.23); fivepoint auscultation 0.18 (0.08-0.36); and the oesophageal detector device 0.05 (0.02-0.09). Tests to exclude events that invariably lead to severe damage or death must have a negligible false positive rate. Misting or auscultation have too high a false positive rate to reliably exclude oesophageal intubation and there is insufficient evidence to support the use of `hang-up´or chest rise. The oesophageal detector device may be considered where other more reliable means are not available, though waveform capnography remains the reference standard for confirmation of tracheal intubation.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis

et al. 2023

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Analytic Review: Confirmation of Endotracheal Tube Position: A Narrative Review

Rudraraju

Eisen

2009

J Intensive Care Med

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Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. Strengths and weaknesses of particular methods are highlighted. Although many physical examination maneuvers have been described, reliance on the physical examination alone is insufficient for confirmation. Touted methods that appear failsafe, such as direct visualization of the ETT traversing the vocal cords have limitations, especially when dealing in the emergency setting accompanying a difficult to visualize airway. While carbon dioxide detection is an excellent confirmatory method, it is not infallible. Esophageal detection devices are useful as an alternative means of confirmation. New methods such as ultrasonic location of the ETT show promise but require further study. The clinician performing ETT insertion should have multiple confirmation methods that allow the practitioner to adapt to a variety of clinical situations, depending on local costs and availability. Finally, when the clinician still has uncertainty, or multiple tests give conflicting results, the availability of bronchoscopy at the bedside to visualize the carina through the ETT is useful.

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Electromyography as a new means of navigation during endotracheal intubation

Levert

Ganapathy

Terry

et al. 2015

Journal of Medical Engineering & Technology

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This study tested a method of using rapid analysis of electromyographic response patterns to electrical stimulation to enable real-time navigation during endotracheal intubation. An electromyographic response detection device was constructed and integrated into a standard endotracheal tube. The rebound rates of the response voltages were measured in the trachea and oesophagus after stimulation in an acute study performed in three freshly euthanized male Suffolk sheep. In a blind study, a physician attempted to identify the tissue type solely from the electrical response signals. In the acute study, the observed rebound rate was found to be significantly faster in tracheal tissue (2.21 × 10(-3) V s(-1)) than in oesophageal tissue (3.45 × 10(-2) V s(-1); p = 0.000 05). In the blind study, the physician correctly determined the oesophagus response rate seven out of eight times and the tracheal rate eight out of nine times. These results suggest that electromyographic responses can be used to accurately differentiate tracheal from oesophageal tissue during ETT insertion, thus offering a valuable new means of enhancing patient safety.

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Clinical test to confirm tracheal intubation: a new method to confirm endotracheal intubation in the absence of capnography

Cited by 3 publications

References 9 publications

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis

Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis

Analytic Review: Confirmation of Endotracheal Tube Position: A Narrative Review

Electromyography as a new means of navigation during endotracheal intubation

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