Use of the Self-Inflating Bulb for Detecting Esophageal Intubation After ???Esophageal Ventilation???

Abstract

This present investigation tests the efficacy of the self-inflating bulb for detecting esophageal intubation after intentional "esophageal ventilation" to mimic gastric insufflation after bag-and-mask ventilation. In 72 anesthetized patients, the trachea and esophagus were intubated with identical tubes. The efficacy of the bulb was tested by a second anesthesiologist before and after the delivery of three breaths at a tidal volume of 300-350 mL each. The pressures generated by the bulb connected to esophageally placed tubes were measured in 10 patients. In all patients, the second anesthesiologist reported no reinflation of the bulbs when connected to esophageally placed tubes and instantaneous reinflation when connected to tracheally placed tubes, thus correctly identifying the location of each tube. The mean negative pressure generated when compressed bulbs were connected to esophageally placed tubes was 55.4 +/- 1.2 mm Hg before esophageal ventilation and 59.0 +/- 0.68 mm Hg after esophageal ventilation. We conclude that insufflation of the stomach as a result of esophageal ventilation, to the extent demonstrated in this study, does not interfere with the effectiveness of the bulb in differentiating esophageal from tracheal intubation.

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

“…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].…”

Case report: A normal capnogram despite esophageal intubation

“…This principle is utilized by an esophageal detector device, which has been shown to be reliable in detecting esophageal intubation in paralyzed patients. 13,14 Our patient was breathing spontaneously and the esophagus remained open; the lumen widened during inspiration and narrowed during expiration.…”

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.…”