Condensation on tracheal tubes is commonly seen with oesophageal intubation

Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*

“…4 ). However, examination findings are frequently reassuring even when the tube is in the oesophagus [ 72 , 73 , 74 , 75 , 121 , 141 , 142 , 143 ]. Misplaced reliance on clinical examination is common in cases of fatal unrecognised oesophageal intubation [ 9 , 10 , 15 , 16 , 17 , 30 ].…”

“…In every case of unrecognised oesophageal intubation reviewed for this guideline in which lung auscultation was undertaken, breath sounds were reported to be heard [ 9 , 10 , 15 , 16 , 28 , 30 , 144 ]. Misting of the tube on exhalation, chest rise, absence of abdominal distension, lung/epigastric auscultation, bougie ‘hold up’ and chest x‐ray should therefore not be used to exclude oesophageal intubation [ 72 , 73 , 74 , 75 , 121 , 141 , 142 , 143 ]. While a minority of these findings can reliably confirm oesophageal intubation [ 121 , 141 , 142 ], this is of limited practical value as failure to confirm oesophageal intubation does not equate with excluding it, so the tube must be removed regardless of examination findings.…”

“…Misting of the tube on exhalation, chest rise, absence of abdominal distension, lung/epigastric auscultation, bougie `hold upá nd chest x-ray should therefore not be used to exclude oesophageal intubation [72-75, 121, 141-143]. While a minority of these findings can reliably confirm oesophageal intubation [121,141,142], this is of limited practical value as failure to confirm oesophageal intubation does not equate with excluding it, so the tube must be removed regardless of examination findings.…”

Delayed recognition of esophageal intubation

“…Haridas, however, reported 42 of 60 esophageal intubations showing condensation. 10 It is well documented that condensation can occur from gas emanating from the stomach. 7,9,10 This observation has proven to be unreliable, even as a supplementary sign.…”

Clinical examination may increase but not decrease suspicion of oesophageal intubation

“…suggest it should be used, is noted in the guidelines but the implications of such findings must be framed appropriately. For example, the absence of tube misting makes oesophageal intubation highly likely but its presence has minimal predictive value regarding tube position [3–5]. As such, we would caution against the frequently observed recitation of ‘we have tube misting’ following initial ventilation.…”