The Self-inflating Bulb for Confirmation of Tracheal Intubation

Wafai, Yaser; Salem, M. Ramez; Joseph, Nandhini; Baraka, Anis

doi:10.1097/00000542-199409001-01303

Cited by 12 publications

(4 citation statements)

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“…4). Its use and limitations are described in more detail elsewhere [118][119][120]. Provided the connection with the tube is airtight, both bulb and syringe design devices are able to distinguish between tracheal and oesophageal placement with >97% accuracy when used in an appropriate patient group, but may yield unreliable results in infants, parturients, morbidly obese patients and some specific contexts [118,[120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139].…”

Section: Oesophageal Detector Devicementioning

confidence: 99%

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

et al. 2022

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Section: Oesophageal Detector Devicementioning

confidence: 99%

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

et al. 2022

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“…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.…”

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%

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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“…Wafai et al conducted a study in adults comparing the on-deflate and off-deflate methods and found an overall bulb inaccuracy rate of approximately 4%. 3 However, this study enrolled more than 2,000 patients, which would have been logistically difficult to duplicate. Based on the results of the Wafai study, we predicted that the inaccuracy rate would be higher in the pediatric population; therefore, our sample size was based on an estimated overall self-inflating bulb inaccuracy rate of 8%.…”

Section: Methodsmentioning

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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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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The Self-inflating Bulb for Confirmation of Tracheal Intubation

Cited by 12 publications

References 0 publications

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

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

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

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

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