A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model

Georg M Schmölzer, Risha Bhatia, Peter G Davis, David G Tingay
Pediatric Pulmonology 2013, 48 (2): 138-45

RATIONALE: Endotracheal tube (ETT) malposition is common and an increasing number of non-invasive techniques to aid rapid identification of tube position are available. Electrical impedance tomography (EIT) is advocated as a tool to monitor ventilation.

OBJECTIVE: This study aimed to compare EIT with five other non-invasive techniques for identifying ETT position in a piglet model.

METHODOLOGY: Six saline lavage surfactant-depleted piglets were studied. Periods of ventilation with ETT placed in the oesophagus or a main bronchus (MB) were compared with an appropriately placed mid-tracheal ETT. Colorimetric end-tidal CO(2) (Pedi-Cap®), SpO(2) and heart rate, tidal volume (${\rm V}_{{\rm T}_{{\rm ao}} } $) using a hot-wire anemometer at the airway opening, tidal volume using respiratory inductive plethysmography (${\rm V}_{{\rm T}_{{\rm RIP}} } $) and regional tidal ventilation within each hemithorax (EIT) were measured.

RESULTS: Oesophageal ventilation: Pedi-Cap® demonstrated absence of color change. ${\rm V}_{{\rm T}_{{\rm ao}} } $, ${\rm V}_{{\rm T}_{{\rm RIP}} } $, and EIT correctly demonstrated no tidal ventilation. SpO(2) decreased from mean (SD) 96 (2)% to 74 (12)% (P < 0.05; Bonferroni post-test), without heart rate change. MB ventilation: SpO(2) , heart rate and Pedi-Cap® were unchanged compared with mid-tracheal position. ${\rm V}_{{\rm T}_{{\rm ao}} } $ and ${\rm V}_{{\rm T}_{{\rm RIP}} } $ decreased from a mean (SD) 10.8 (5.6) ml/kg and 14.6 (6.2) ml/kg to 5.5 (1.9) ml/kg and 6.4 (2.6) ml/kg (both P < 0.05; Bonferroni post-test). EIT identified the side of MB ventilation, with a mean (SD) 95 (3)% reduction in tidal volume in the unventilated lung.

CONCLUSIONS: EIT not only correctly identified oesophageal ventilation but also localized the side of MB ventilation. At present, no one technique is without limitations and clinicians should utilize a combination in addition to clinical judgement.

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