Endotracheal tube malposition within the pediatric population: A common event despite clinical evidence of correct placement

Eric Harris, Kristopher Arheart, Donald H. Penning

Research output: Contribution to journalArticle

17 Citations (Scopus)

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 languageEnglish
Pages (from-to)685-690
Number of pages6
JournalCanadian Journal of Anesthesia
Volume55
Issue number10
DOIs
StatePublished - Oct 1 2008

Fingerprint

Fluoroscopy
Pediatrics
Operating Rooms
Population
Incidence
Thorax
Intensive Care Units
Ventilation
Logistic Models

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 journalArticle

@article{cf318056b0f344d4a2cd12a09e0140d7,
title = "Endotracheal tube malposition within the pediatric population: A common event despite clinical evidence of correct placement",
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.",
author = "Eric Harris and Kristopher Arheart and Penning, {Donald H.}",
year = "2008",
month = "10",
day = "1",
doi = "10.1007/BF03017744",
language = "English",
volume = "55",
pages = "685--690",
journal = "Canadian journal of anaesthesia = Journal canadien d'anesth{\'e}sie",
issn = "0008-2856",
publisher = "Canadian Anaesthetists Society",
number = "10",

}

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 -