Abstract
Purpose: To ensure that the endotracheal tube (ETT) is ideally placed for proper ventilation, radiographic confirmation of ETT placement is frequently used to supplement clinical examination in the intensive care unit setting. However, fluoroscopy rarely serves the same role during surgery, despite the fact that portable units are often present in the operating room. The purpose of this study was to ascertain the value of fluoroscopy in determining ETT malposition among the pediatric surgical population. Methods: Chest radiographs from 257 children (age 12 days-12 yr), who presented for a total of 446 individual procedures in the fluoroscopy suite, were studied to determine the incidence of ETTs placed too shallow (above the inferior clavicular border) or too deep (at or below the carina). A logistic regression with outcomes of correct and incorrect was used to analyze the data points. Results: Eighteen percent of all the radiographs showed initial improper ETT placement, despite clinical evidence suggesting the contrary. The peak incidence of malposition, which occurred in patients under one year old, reached 35%. Incidence decreased with advancing age, but remained over 10% until the age of ten. A second attempt at positioning the tube, based on information from the chest radiograph, was successful in 95% of the cases. The remaining 5% required placement of the ETT under continuous fluoroscopic guidance. Conclusion: Fluoroscopy, when readily available in the operating room, is a safe and useful technique to ensure proper ETT placement among the pediatric population.
| Original language | English |
|---|---|
| Pages (from-to) | 685-690 |
| Number of pages | 6 |
| Journal | Canadian Journal of Anesthesia |
| Volume | 55 |
| Issue number | 10 |
| DOIs | |
| State | Published - Oct 1 2008 |
Fingerprint
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine
Cite this
Endotracheal tube malposition within the pediatric population : A common event despite clinical evidence of correct placement. / Harris, Eric; Arheart, Kristopher; Penning, Donald H.
In: Canadian Journal of Anesthesia, Vol. 55, No. 10, 01.10.2008, p. 685-690.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Endotracheal tube malposition within the pediatric population
T2 - A common event despite clinical evidence of correct placement
AU - Harris, Eric
AU - Arheart, Kristopher
AU - Penning, Donald H.
PY - 2008/10/1
Y1 - 2008/10/1
N2 - Purpose: To ensure that the endotracheal tube (ETT) is ideally placed for proper ventilation, radiographic confirmation of ETT placement is frequently used to supplement clinical examination in the intensive care unit setting. However, fluoroscopy rarely serves the same role during surgery, despite the fact that portable units are often present in the operating room. The purpose of this study was to ascertain the value of fluoroscopy in determining ETT malposition among the pediatric surgical population. Methods: Chest radiographs from 257 children (age 12 days-12 yr), who presented for a total of 446 individual procedures in the fluoroscopy suite, were studied to determine the incidence of ETTs placed too shallow (above the inferior clavicular border) or too deep (at or below the carina). A logistic regression with outcomes of correct and incorrect was used to analyze the data points. Results: Eighteen percent of all the radiographs showed initial improper ETT placement, despite clinical evidence suggesting the contrary. The peak incidence of malposition, which occurred in patients under one year old, reached 35%. Incidence decreased with advancing age, but remained over 10% until the age of ten. A second attempt at positioning the tube, based on information from the chest radiograph, was successful in 95% of the cases. The remaining 5% required placement of the ETT under continuous fluoroscopic guidance. Conclusion: Fluoroscopy, when readily available in the operating room, is a safe and useful technique to ensure proper ETT placement among the pediatric population.
AB - Purpose: To ensure that the endotracheal tube (ETT) is ideally placed for proper ventilation, radiographic confirmation of ETT placement is frequently used to supplement clinical examination in the intensive care unit setting. However, fluoroscopy rarely serves the same role during surgery, despite the fact that portable units are often present in the operating room. The purpose of this study was to ascertain the value of fluoroscopy in determining ETT malposition among the pediatric surgical population. Methods: Chest radiographs from 257 children (age 12 days-12 yr), who presented for a total of 446 individual procedures in the fluoroscopy suite, were studied to determine the incidence of ETTs placed too shallow (above the inferior clavicular border) or too deep (at or below the carina). A logistic regression with outcomes of correct and incorrect was used to analyze the data points. Results: Eighteen percent of all the radiographs showed initial improper ETT placement, despite clinical evidence suggesting the contrary. The peak incidence of malposition, which occurred in patients under one year old, reached 35%. Incidence decreased with advancing age, but remained over 10% until the age of ten. A second attempt at positioning the tube, based on information from the chest radiograph, was successful in 95% of the cases. The remaining 5% required placement of the ETT under continuous fluoroscopic guidance. Conclusion: Fluoroscopy, when readily available in the operating room, is a safe and useful technique to ensure proper ETT placement among the pediatric population.
UR - http://www.scopus.com/inward/record.url?scp=56049098567&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=56049098567&partnerID=8YFLogxK
U2 - 10.1007/BF03017744
DO - 10.1007/BF03017744
M3 - Article
C2 - 18835966
AN - SCOPUS:56049098567
VL - 55
SP - 685
EP - 690
JO - Canadian journal of anaesthesia = Journal canadien d'anesthésie
JF - Canadian journal of anaesthesia = Journal canadien d'anesthésie
SN - 0008-2856
IS - 10
ER -