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Comparison of three different methods to confirm tracheal tube placement in emergency intubation.
Intensive Care Med. 2002 Jun; 28(6):701-4.IC

Abstract

OBJECTIVES

Verification of endotracheal tube placement is of vital importance, since unrecognized esophageal intubation can be rapidly fatal (death, brain damage). The aim of our study was to compare three different methods for immediate confirmation of tube placement: auscultation, capnometry and capnography in emergency conditions in the prehospital setting.

DESIGN AND SETTING

Prospective study in the prehospital setting.

PATIENTS AND INTERVENTIONS

All adult patients (>18 years) were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry was performed with infrared capnometry and capnography with infrared capnography. The examiners looked for the characteristic CO(2) waveform and value of end-tidal carbon dioxide (EtCO(2)) in millimeters of mercury. Determination of final tube placement was performed by a second direct visualization with laryngoscope. Data are mean +/- SD and percentages.

MEASUREMENTS AND RESULTS

Over a 4year period, 345 patients requiring emergency intubation were included. Indications for intubation included cardiac arrest (n=246; 71%) and non-arrest conditions (n=99; 29%). In nine (2.7%) patients, esophageal tube placement occurred. The esophageal intubations were followed by successful endotracheal intubations without complications. The capnometry (sensitivity and specificity 100%) and capnography (sensitivity and specificity 100%) were better than auscultation (sensitivity 94% and specificity 83%) in confirming endotracheal tube placement in non-arrest patients (p<0.05). Capnometry was highly specific (100%) but not sensitive (88%) for correct endotracheal intubation in patients with cardiopulmonary arrest (capnometry versus auscultation and capnometry versus capnography, p<0.05).

CONCLUSION

Capnography is the most reliable method to confirm endotracheal tube placement in emergency conditions in the prehospital setting.

Authors+Show Affiliations

Emergency Medical Service - Prehospital unit, Ljubljanska 5, Maribor 2000, Slovenia. grmec-mis@siol.net

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

12107674

Citation

Grmec, Stefek. "Comparison of Three Different Methods to Confirm Tracheal Tube Placement in Emergency Intubation." Intensive Care Medicine, vol. 28, no. 6, 2002, pp. 701-4.
Grmec S. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med. 2002;28(6):701-4.
Grmec, S. (2002). Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Medicine, 28(6), 701-4.
Grmec S. Comparison of Three Different Methods to Confirm Tracheal Tube Placement in Emergency Intubation. Intensive Care Med. 2002;28(6):701-4. PubMed PMID: 12107674.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of three different methods to confirm tracheal tube placement in emergency intubation. A1 - Grmec,Stefek, Y1 - 2002/04/30/ PY - 2001/08/21/received PY - 2002/03/12/accepted PY - 2002/7/11/pubmed PY - 2002/10/9/medline PY - 2002/7/11/entrez SP - 701 EP - 4 JF - Intensive care medicine JO - Intensive Care Med VL - 28 IS - 6 N2 - OBJECTIVES: Verification of endotracheal tube placement is of vital importance, since unrecognized esophageal intubation can be rapidly fatal (death, brain damage). The aim of our study was to compare three different methods for immediate confirmation of tube placement: auscultation, capnometry and capnography in emergency conditions in the prehospital setting. DESIGN AND SETTING: Prospective study in the prehospital setting. PATIENTS AND INTERVENTIONS: All adult patients (>18 years) were intubated by an emergency physician in the field. Tube position was initially evaluated by auscultation. Then, capnometry was performed with infrared capnometry and capnography with infrared capnography. The examiners looked for the characteristic CO(2) waveform and value of end-tidal carbon dioxide (EtCO(2)) in millimeters of mercury. Determination of final tube placement was performed by a second direct visualization with laryngoscope. Data are mean +/- SD and percentages. MEASUREMENTS AND RESULTS: Over a 4year period, 345 patients requiring emergency intubation were included. Indications for intubation included cardiac arrest (n=246; 71%) and non-arrest conditions (n=99; 29%). In nine (2.7%) patients, esophageal tube placement occurred. The esophageal intubations were followed by successful endotracheal intubations without complications. The capnometry (sensitivity and specificity 100%) and capnography (sensitivity and specificity 100%) were better than auscultation (sensitivity 94% and specificity 83%) in confirming endotracheal tube placement in non-arrest patients (p<0.05). Capnometry was highly specific (100%) but not sensitive (88%) for correct endotracheal intubation in patients with cardiopulmonary arrest (capnometry versus auscultation and capnometry versus capnography, p<0.05). CONCLUSION: Capnography is the most reliable method to confirm endotracheal tube placement in emergency conditions in the prehospital setting. SN - 0342-4642 UR - https://www.unboundmedicine.com/medline/citation/12107674/Comparison_of_three_different_methods_to_confirm_tracheal_tube_placement_in_emergency_intubation_ L2 - https://dx.doi.org/10.1007/s00134-002-1290-x DB - PRIME DP - Unbound Medicine ER -