Efficacy of the Self-inflating Bulb in Confirming Tracheal Intubation in the Morbidly Obese

Abstract

Contrary to previous investigations in healthy patients, the current study demonstrates a high incidence of false-negative results when the SIB is used to confirm tracheal intubation in morbidly obese patients. If the SIB is used, the technique should include compression of the SIB after connection to the tube and should be used in conjunction with other clinical signs and technical aids. The mechanism of false-negative results in these patients seems to be related to reduction of caliber of airways secondary to a marked decrease in functional residual capacity, and collapse of large airways due to invagination of the posterior tracheal wall when sub-atmospheric pressure is generated by the SIB.

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity

“…A conclusion from the ASA Closed Claims Study was that the combination of pulse oximetry and capnography bcould be expectedQ to help prevent anesthetic-related morbidity and mortality [1]. Indirect clinical confirmatory tests are prone to misinterpretation and hence may be supplemented by capnography in the OR and portable devices such as a battery-powered capnogram device, an esophageal detector device/bulb syringe, or a disposable carbon dioxide detector outside the OR [12,13]. Their penetration has been incomplete compared to the OR: incomplete availability in the these location plus their inconsistent incorporation in each and every case [7,8].…”

“…Despite efforts to make EI detection devices readily accessible, their penetration into clinical practice at our institution had been less than complete during this period. Personal constraints in our institution limited the use of the battery-operated carbon dioxide detector (must be carried to the bedside) and the esophageal detector/bulb syringe (marginally palatable compared to the convenience of the anesthesia machine -based capnography and a curtailed faith in its use) [12,13]. The findings of this practice analysis prompted our institution to add a disposable carbon dioxide detector to each of the emergency intubation equipment box that is immediately available in each hospital locations (n = 70 sites) for use at the patient's bedside.…”

Part 10: Pediatric Advanced Life Support

“…84,85 In adults in cardiac arrest the esophageal detector device is useful to identify esophageal intubation, and it therefore can be used to supplement the potentially misleading information from exhaled CO 2 detection to confirm tracheal placement. 86 Although an esophageal detector device has been used successfully in children, 87 it appears to be unreliable in children Ͻ1 year of age, 88 in morbidly obese patients, 89 and in patients in late pregnancy. 90 In summary, there is insufficient data in emergency intubations in infants and children to recommend the routine use of an esophageal detector device (Class Indeterminate; LOE 5, 6, 7).…”

Airway auscultationA new method of confirming tracheal intubation

“…The SCOTI (Sonomatic Confirmation of Tracheal Intubation) is a new device which utilises recognition of resonating frequency to determine whether the tube is in the trachea or oesophagus [7]. Capnography, the oesophageal detector device and the SCOTI all have a number of limitations [8][9][10][11][12][13][14]. The features of an ideal test for detecting oesophageal intubation have been described [2] but as yet such a test does not exist.…”