Efficacy of the Self-inflating Bulb in Detecting Esophageal Intubation  Does the Presence of a Nasogastric Tube or Cuff Deflation Make a Difference?

Salem, M. Ramez; Wafai, Yaser; Joseph, Ninos J.; Baraka, Anis; Czinn, Edward A.

doi:10.1097/00000542-199401000-00010

Cited by 36 publications

(10 citation statements)

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“…The investigators found that the insufflation of the stomach as a result of esophageal ventilation did not interfere with the effectiveness of the bulb in differentiating between esophageal and tracheal intubations. 5 Our study confirms these results in pediatric patients. Although false negatives did occur in both techniques tested, this finding is not as concerning, since any suspicious tube placements should be visually rechecked.…”

Section: Discussionsupporting

confidence: 89%

“…When the self-inflating bulb is compressed and the ETT is in the rigid trachea, free aspiration of air occurs and the bulb re-expands. 5 If the vacuum is applied to a collapsible esophagus, however, no free aspiration of air occurs and the bulb should remain compressed. The advantage of the esophageal bulb is that it does not depend on carbon dioxide (CO 2 ) production and, therefore, remains accurate even in patients who have suffered cardiac arrest or are in low cardiac output states, where CO 2 production may not be detectable.…”

Section: Discussionmentioning

confidence: 99%

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The Self-inflating Bulb as an Airway Adjunct: Is It Reliable in Children Weighing Less than 20 Kilograms?

et al. 2003

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Objectives: To confirm the ability of the self-inflating bulb to indicate endotracheal tube (ETT) position in children weighing less than 20 kilograms, and to determine whether the presence of air in the stomach affects the bulb's accuracy. Methods: This single-blind, prospective, single-cohort, repeated-measures, equivalence study was conducted in the operating room of a children's hospital. Seventy patients weighing less than 20 kilograms were enrolled. All patients had an uncuffed ETT placed in both the trachea and the esophagus. Measurements were initially obtained on both tubes without the presence of air in the stomach using the on-deflate method (the bulb is compressed after attachment to the ETT). Five mL/kg of air was then insufflated into the stomach and two additional measurements were obtained on each patient. The order in which the bulb was checked was determined by a computer-generated permuted block randomization scheme. The blinded assessor told the anesthesiologist when to start and stop the clock after each intervention. Five seconds was used as the cutoff time for which the clock was stopped. If the bulb re-expanded within 5 seconds, then the tube was considered to be in the trachea; if it did not re-expand, then this was considered to be an esophageal intubation. Results: Median patient age was 2 years. The on-deflate method without air in the stomach had a sensitivity of 100% and a specificity of 94% for detecting tracheal intubations. With air in the stomach, the bulb had a sensitivity of 97% and a specificity of 96% (95% confidence interval [95% CI] for the difference between methods: sensitivity À3 to 10; specificity À10 to 7). The inaccuracy rate for the on-deflate method without air in the stomach was 3%, whereas the inaccuracy rate with air in the stomach was 4% (D À1, 95% CI ¼ À5 to 4).

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

The Self-inflating Bulb as an Airway Adjunct: Is It Reliable in Children Weighing Less than 20 Kilograms?

et al. 2003

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“…14 Several other studies have found similar results in patients undergoing endotracheal intubation. [16][17][18] We believed that the same principles could be used to determine the accuracy of placement of NG tubes. Th e absence of CO 2 on the colorimetric device, or the delayed or absence of infl ation of the SIBS, would indicate esophageal placement, while the presence of CO 2 or rapid infl ation of the bulb would suggest nonesophageal placement.…”

Section: Human Experimental Protocolmentioning

confidence: 99%

Comparison of a Self-Inflating Bulb Syringe and a Colorimetric CO 2 Indicator With Capnography and Radiography to Detect the Misdirection of Naso/Orogastric Tubes Into the Airway of Critically Ill Adult Patients

Smyrnios

Lenard

Rajan

et al. 2015

Chest

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“…More recent ways of confirming an airway has also included an end-tidal CO 2 detector, syringe plunger aspiration, and self-inflating bulb (Ellick's device). 18,19 The CO 2 detector has an overall sensitivity of 80% and specificity of 96%, which reaches close to 100% in patients with spontaneous respiration. The overall poor sensitivity is attributed primarily to cardiac arrest patients who have a very low-flow state which may minimize color change.…”

Section: 6mentioning

confidence: 99%

Complications of a Retrograde Intubation in a Trauma Patient

Wijesinghe

Gough

2000

Academic Emergency Medicine

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Abstract. The authors report the case of an elder woman involved in a motor vehicle collision (MVC) requiring emergent intubation using the technique of retrograde intubation (RI). Since RI is a blind technique, potential complications arising from its use are numerous and may result in increased morbidity and mortality. Such was the case of this RI that involved incorrect placement of the endotracheal tube (ETT), resulting in suboptimal ventilation and increased morbidity. Additionally, this case illustrates how the failure to detect this error in multiple settings (ambulance, helicopter, emergency department) led to unnecessary and potentially deleterious procedures and significant delay in providing the basics of trauma care, oxygenation and ventilation. Although theoretical complications of RI have been addressed in the past, there have been very few published reports of actual complications. The emergency physician must be aware of difficult airways, options available to establish alternative airways, and methods to confirm appropriate placement of the ETT. The authors also discuss the indications, procedures, and complications involved in performing an RI. Key words: endotracheal intubation; retrograde intubation; airway. ACADEMIC EMERGENCY MEDICINE 2000; 7: 1267-1271 R ETROGRADE intubation (RI) has been used successfully in patients with difficult airways as an alternative method of establishing a definitive airway when more conventional and less-invasive methods are unsuccessful. As opposed to surgical cricothyrotomy, RI is less invasive and requires minimal training.1,2 This case illustrates one of many possible complications associated with RI. CASE REPORTAn 80-year-old woman was the front-seat, restrained passenger of a severe motor vehicle collision (MVC) requiring prolonged extrication. The local emergency medical services (EMS) unit notified the Level 1 trauma center and requested a scene run by the helicopter service. Prior to the helicopter arrival, the patient was extricated and the decision was made by EMS to transport the patient to a nearby community hospital and meet the flight team at the helipad. The patient was showing signs of severe closed head injury with a Glasgow Coma Scale score (GCS) of 5-6. While awaiting the arrival of the helicopter, the patient had two large-bore intravenous catheters placed for fluid resuscitation in the back of the ambulance. A non-emergency medicine (EM)-trained physician staffing the local emergency department (ED) joined the EMS crew in the ambulance and attempts were made to stabilize the airway using rapid-sequence intubations (RSI). The patient proved to have a very difficult airway and could not be intubated by the EMS personnel or the physician using direct-visualization laryngoscopy. The flight crew arrived and determined that since intubation was unsuccessful using direct laryngoscopy, they would perform RI. The procedure was performed by one of the flight nurses. This nurse had four years of experience as a flight nurse and had received training in...

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Efficacy of the Self-inflating Bulb in Detecting Esophageal Intubation Does the Presence of a Nasogastric Tube or Cuff Deflation Make a Difference?

Cited by 36 publications

References 0 publications

The Self-inflating Bulb as an Airway Adjunct: Is It Reliable in Children Weighing Less than 20 Kilograms?

The Self-inflating Bulb as an Airway Adjunct: Is It Reliable in Children Weighing Less than 20 Kilograms?

Comparison of a Self-Inflating Bulb Syringe and a Colorimetric CO 2 Indicator With Capnography and Radiography to Detect the Misdirection of Naso/Orogastric Tubes Into the Airway of Critically Ill Adult Patients

Complications of a Retrograde Intubation in a Trauma Patient

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