Esophageal Detector Device Research Articles

Invention of the Esophageal Detector Device

Resident in Anesthesiology, Klinikum Ludwigshafen, D-67063 Ludwigshafen, Germany.To the Editor:--Sood et al. ascribe the first description of the esophageal detector to Wee. [1]This is not correct. Wee was an independent reinventor, the namegiver of the "esophageal detector device," and the first to publish a formal study on this issue. [2]But the first description of the syringe test was by Pollard 8 yr earlier.* Pollard and Wee agreed on these facts in the correspondence section of Anesthesia. [3,4].Wolfgang H. Maleck, Resident in Anesthesiology, Klinikum Ludwigshafen, D-67063 Ludwigshafen, Germany.(Accepted for publication April 13, 1995.)* Pollard BJ: A test to verify accurate placement of an endotracheal tube. World Congress of Anaesthesiology, Amsterdam, Excerpta Medica, 1980; Abstract 1112.

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The Esophageal Detector Device

The esophageal detector device (EDD) is a diagnostic tool for confirmation of tracheal intubation. Capnography is the accepted standard for such confirmation. The purpose of this investigation was to determine whether results using the EDD and capnography agree. Five hundred patients were divided into three separate studies. In study 1, with 300 consecutive patients, tracheal intubation was performed and tested with the EDD followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was tested similarly. The tube was then removed and the trachea intubated, and testing followed. Study 3 involved 100 patients and used a double-blind, randomized design. The tube was intentionally inserted into either the esophagus (n = 5) or trachea (n = 49), and testing followed. In study 1, the compressed EDD bulb reinflated 270 times and always agreed with capnography; in 20 of the 270 subjects (7%) bulb reinflation was delayed, taking from 5-30 s. In 30 instances, the bulb remained compressed, and there was no capnogram indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between EDD and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100%, but reinflation of the EDD bulb was delayed in 4% of tracheal intubations. In the 500 patients studied, results from the EDD and capnogram always agreed, but in 6% of all tracheal intubations, the EDD bulb inflated slowly. Of 181 esophageal intubations, the results from the EDD and capnogram always agreed, i.e., there was no reinflation or capnogram. The sensitivity, specificity, and predictive value for the EDD in all of these studies was 100%. The EDD is a valuable diagnostic technique for confirming tracheal intubation. Results using EDD agree with results using capnography; in 6% of instances there is a slow reinflation; and where there is no capnography, such as on hospital wards, EDD may be a useful diagnostic tool.

The Esophageal Detector Device: Accuracy and Reliability in Difficult Airway Settings

The Esophageal Detector Device: Accuracy and Reliability in Difficult Airway Settings

The esophageal detector device: A rapid and accurate method for assessing tracheal versus esophageal intubation in a porcine model

To assess time and accuracy of the esophageal detector device (EDD), disposable end-tidal CO2 monitor (ETCO2), and standard clinical methods for detection of endotracheal tube placement. Prospective, randomized, single-blinded, controlled laboratory investigation. Thirty airway managers (physicians, nurse anesthetists, and paramedics) used one pig (Sus scrofa) as the intubated, respiratory depressed/arrest model. Part 1: A standard 7.5-mm endotracheal tube was placed in either the esophagus or the trachea of the anesthetized swine. Anatomic location was verified by bronchoscopy. Airway managers blinded to the endotracheal tube location were assigned randomly to identify tube position by one of three methods (EDD, ETCO2, or clinical methods). Speed and accuracy of the assessment were recorded. Part 2: A second identical tube was placed, so that both the esophagus and the trachea were intubated; then, the esophageal tube was bag-ventilated for one minute. Each blinded airway manager, using only the EDD, determined placement site of both tubes. Part 1: Mean time to determine tube placement for group A (EDD) was 13.8 seconds; group B (ETCO2), 31.5 seconds; and group C (clinical methods), 39 seconds. Comparison by analysis of variance yielded a value of P less than .001. Both groups A and B were 100% accurate, whereas 30% of the subjects from group C mistakenly assessed an esophageal tube as in the trachea. Part 2: The EDD remained 100% sensitive and specific despite prior ventilation of the esophageal tube. In this porcine model, the EDD and ETCO2 were more accurate than clinical methods in determining endotracheal tube placement. The EDD demonstrated a significant time advantage over both ETCO2 and clinical methods. Prior ventilation of the esophageal tube does not interfere with the accuracy of the EDD.

An evaluation of the esophageal detector device using a cadaver model

The study was conducted to evaluate the usefulness of an esophageal detector device (EDD) to correctly differentiate between esophageal and tracheal intubation. The study was conducted in the emergency department using 10 recently deceased cadavers (nine males, one female, age range 50–72 years). An 8-mm internal diameter endotracheal tube was placed orally into the trachea, and a second 8-mm ID tube was placed orally into the esophagus. Both tubes extended the same distance from the mouth, and the cuffs were not inflated. After placement of the tubes, the EDD was used by advanced life support providers (physicians, nurses, paramedics, and respiratory therapists) to determine if each tube was in the trachea or the esophagus. The persons who assessed the tube placement were not present when the tubes were placed into the cadavers. Multiple evaluators were allowed for each cadaver, but each evaluator only participated one time for each cadaver. The bulb of the EDD was squeezed by the evaluator, who then attached it to the endotracheal tube and rated the bulb inflation as immediate inflation, delayed inflation, or no inflation. Prior to participation in the study, evaluators were instructed in the use of the EDD. There were a total of 45 trials performed on the cadavers (median, four evaluations/cadaver, range, one-eight). For the tracheal tube, the EDD inflated immediately in all cases; it was thus 100% correct in identification of tracheal intubation. For the esophageal tube, the EDD did not inflate in 44 cases, and in one case it filled with vomitus; it thus correctly identified esophageal intubation in all cases. In none of the cases did the EDD have a delayed inflation. All evaluators indicated that the EDD was simple and easy to use. In this cadaver study, the EDD was simple to use and correctly indicated tracheal and esophageal intubation in all cases.

The oesophageal detector device

AnaesthesiaVolume 46, Issue 12 p. 1086-1087 Free Access The oesophageal detector device M. Wee, M. Wee Frenchay Hospital, Bristol BS16 1LESearch for more papers by this author M. Wee, M. Wee Frenchay Hospital, Bristol BS16 1LESearch for more papers by this author First published: December 1991 https://doi.org/10.1111/j.1365-2044.1991.tb09940.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Wee MYK. The oesophageal detector device. Anaesthesia 1988; 43: 27– 9. 2 Calder I, Smith M, Newton M. The oesophageal detector device. Anaesthesia 1989; 44: 705. 3 Williams KN, Nunn JF. The oesophageal detector device. A prospective trial in 100 patients. Anaesthesia 1989; 44: 412– 4. 4 Wee MYK. Comments on the oesophageal detector device. Anaesthesia 1989; 44: 930– 1. Citing Literature Volume46, Issue12December 1991Pages 1086-1087 ReferencesRelatedInformation

The oesophageal detector device

In 100 children between the ages of 1-10 years, observers of differing experience reliably and rapidly detected 50 oesophageal and 50 tracheal intubations in a randomised single-blind trial using the original oesophageal detector device. However, only two children under the age of 2 years were tested and no conclusions can be drawn for this age group from this study.

The oesophageal detector device

The oesophageal detector device

Use of the oesophageal detector device in children under one year of age

The efficacy of a modified oesophageal detector device was evaluated in a single-blind study of 20 healthy infants. It was found to be unreliable as a method to discriminate oesophageal from tracheal intubation in this age group.

Tube placement after difficult intubation

AnaesthesiaVolume 45, Issue 5 p. 420-420 Free Access Tube placement after difficult intubation N.J. Huggins, N.J. Huggins The Queen Elizabeth Hospital, Birmingham B15 2THSearch for more papers by this authorM. Smith, M. Smith The National Hospital for Nervous Diseases, London WC1 3BGSearch for more papers by this authorD.A. Jewkes, D.A. Jewkes The National Hospital for Nervous Diseases, London WC1 3BGSearch for more papers by this author N.J. Huggins, N.J. Huggins The Queen Elizabeth Hospital, Birmingham B15 2THSearch for more papers by this authorM. Smith, M. Smith The National Hospital for Nervous Diseases, London WC1 3BGSearch for more papers by this authorD.A. Jewkes, D.A. Jewkes The National Hospital for Nervous Diseases, London WC1 3BGSearch for more papers by this author First published: May 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14810.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Cormack RS, Lehane J. Difficult tracheal intubation in obstetrics. Anaesthesia 1984; 39: 1105– 11. 2 Wee MYK. The oesophageal detector device. Assessment of a new method to distinguish oesophageal from tracheal intubation. Anaesthesia 1988; 43: 27– 9. 3 Stanley TH, Liu W-S. Tracheostomy and endotracheal tube cuff volume and pressure changes during thoracic operations. Annals of Thoracic Surgery 1975; 20: 144– 51. Volume45, Issue5May 1990Pages 420-420 ReferencesRelatedInformation

Oesophageal detector device

Oesophageal detector device

Oesophageal detector device

Oesophageal detector device