Discrimination ability of the endotracheal tube location using real-time palpation during intubation using an endotracheal tube with a preloaded stylet

Abstract

PurposePalpation during intubation could be used as an ancillary method of providing real-time information of the endotracheal tube (ETT) placement before manual ventilation. This study aimed to evaluate the ability to discriminate the ETT location using a modified real-time palpation method with a preloaded stylet during intubation.Patients and methodsThe examiner performing the real-time palpation method placed three fingers on the lateral sides of the trachea between the sternal notch and the thyroid cartilage to determine if endotracheal intubation was successful. Endotracheal intubation was confirmed by auscultation and quantitative carbon dioxide waveform using capnography.ResultsEighty-eight patients were enrolled in this study. The discrimination accuracy of the real-time palpation method was 98.9% (95% CI: 93.8–99.8) for identifying the location of ETT between the trachea and esophagus. There was one false negative, reported as esophageal intubation rather than tracheal intubation.ConclusionThe real-time palpation method during intubation using an ETT with a preloaded stylet is an instantly applicable technique with good discrimination ability. The addition of real-time information through this palpation method to the conventional intubation process, especially in patients with poor vocal cord visualization, would be useful to facilitate the process of safe and careful endotracheal intubation.

Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients

“…The reported incidence of esophageal intubation among patients without obesity varies from 1.25% to 8.6%, which is markedly lower than the rate obtained for the obese patients in our study (13.8%) . This finding may be related to the anatomic changes in the upper airway of patients with obesity.…”

“…19 The reported incidence of esophageal intubation among patients without obesity varies from 1.25% to 8.6%, which is markedly lower than the rate obtained for the obese patients in our study (13.8%). [20][21][22] This finding may be related to the anatomic changes in the upper airway of patients with obesity. These changes include oropharyngeal crowding, narrowing of the upper airway, macroglossia, retrognathia, a thick neck, a reduced mandibular length, an inferiorly positioned hyoid bone, and a retroposition of the maxilla.…”

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

“…Of these, we excluded 31, and following a detailed assessment included 49 studies (29 observational, 18 randomised controlled trials, 2 studies where the design was not reported) involving 10,654 participants in the final review (Fig. 1) [3, 18–65]. Overall, the median number of participants per study was 67.5.…”

“…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].…”

“…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].…”