Inadvertent Esophageal Intubation Research Articles

7400 Gastric Injury at Laparoscopy for Gynaecological Indications: A Systematic Review

<h3>Study Objective</h3> To identify causes of gastric injury at laparoscopy for gynaecological indications and determine optimal management. <h3>Design</h3> A prospectively registered systematic review (PROSPERO CRD42021237999) was undertaken and performed according to PRISMA guidelines. <h3>Setting</h3> Databases searched included Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), Medline, Embase, Web of Science, SCOPUS and Google Scholar from to January 2021. <h3>Patients or Participants</h3> All study types were included involving female patients of any age with gastric injuries undergoing laparoscopic surgery for any gynaecological indication. <h3>Interventions</h3> Laparoscopic surgery for any gynaeoclogical indications. <h3>Measurements and Main Results</h3> 6294 articles were screened from which 67 studies were selected for a full-text review. 28 articles satisfied inclusion criteria which contained 42 cases which were comprised of 7 observational studies (1 prospective, 6 retrospective) observational studies, 4 case series and 17 case reports. 93% (39/42) of reported injuries occurred at the time of laparoscopic entry where Veress entry technique was utilised in 74% of cases (31/42). Eighteen cases had entry point reported, with 33% (14/42) occurring at periumbilical entry point with 5% (2/42) occurring at Palmer's point. The commonest site of gastric injury was superficial, on the anterior stomach (n=8) or at the greater curvature (n=5). Of the reported aetiology, 21% (9/42) were anaesthetic related (i.e., inadvertent oesophageal intubation, prolonged or failed oxygenation). Of the patients with reported management (32/42), a similar proportion of patients were managed conservatively (n=11) when compared to laparotomy (n=13) or via laparoscopy (n=8). All injuries were detected intraoperatively with all patients recovering well with no reported long-term sequelae <h3>Conclusion</h3> This review of the literature reveals that gastric injury at laparoscopy for gynaecological indications is a rare complication predominantly occurring during laparoscopic entry, most commonly at periumbilical entry point. When detected intraoperatively, conservative management or laparoscopic repair in the appropriate patient is often adequate with no apparent long term sequalae.

Assessment of endotracheal intubation procedures following inadvertent esophageal intubation. A randomized crossover manikin trial

Abstract&#x0D; Objective: To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation.&#x0D; Methods: The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E- getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22.&#x0D; Results: There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05±9.65 and for E- it was 17.55±11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85±12.66 seconds and E- had 16.75±8.66. With video laryngoscope, E+ group had a mean completion time of 16.75±8.66 seconds, while E- had it 14.60±8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p&gt;0.05).&#x0D; Conclusion: In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type.&#x0D; Continuous… &#x0D;

Assessment of endotracheal intubation procedures following inadvertent esophageal intubation. A randomized crossover manikin trial.

To evaluate the success, degree of difficulty and completion time of endotracheal intubation without removing the endotracheal tube in the event of an oesophageal intubation.. The prospective, randomised crossover study was conducted at Gulhane Training and Research Hospital, Ankara, Turkey, from July 1, 2018, to August 31, 2018, and used a manikin model. Endotracheal intubation was performed using Miller, Macintosh blades and a video laryngoscope. The procedures were randomised into two groups, with group E+ being subjected to it while an endotracheal tube ETT was placed in the oesophagus (E+) simulating the oesophageal intubation, and control group E- getting the standard procedure without the endotracheal tube in the oesophagus. All methods were evaluated for their success, completion time, and degree of difficulty. Data was analysed using SPSS 22. There were 120 manikins, with 60(50%) in each of the two groups. The mean completion time with Miller in E+ group was 19.05±9.65 and for E- it was 17.55±11.95 seconds. With Macintosh, E+ had a mean completion time of 19.85±12.66 seconds and E- had 16.75±8.66. With video laryngoscope, E+ group had a mean completion time of 16.75±8.66 seconds, while E- had it 14.60±8.17. No significant difference was found in the paired group comparisons in terms of the degree of task difficulty (p>0.05). In case of inadvertent oesophageal intubation condition, leaving the tube in the oesophagus and performing subsequent endotracheal intubation attempts was not found to decrease the rate of success regardless of the laryngoscope type.

A novel training simulator for portable ultrasound identification of incorrect newborn endotracheal tube placement \u2013 observational diagnostic accuracy study protocol

BackgroundEndotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children.MethodsThis will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods.DiscussionThis study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support.Trial registrationClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.

Monitoring during difficult airway management

Monitoring is crucial to assure safety during difficult airway management. Several reports have indicated that the most of the adverse outcomes associated with difficult airway management could have been avoided with the use of necessary monitors, such as a pulse oximeter and a capnometer. Nevertheless, airway complications continue to be major problems during anesthesia, in particular, in patients with difficult airways. In this brief review, I stress the role of monitoring in detecting inadvertent esophageal intubation, during sedation for awake tracheal intubation, during general anesthesia, and during emergence from anesthesia, in patients with difficult airways.

SHORT COMMUNICATION A Potential Method for Safe Recovery from Recognized Inadvertent Esophageal Intubation

How to proceed following inadvertent esophageal intubation and what to do with the misplaced endotracheal tube is controversial and not specifically addressed in the difficult airway algorithm from the American Society of Anesthesiologists. Here we describe a simple and effective strategy to manually ventilate the patient with an air cushioned face mask while leaving the endotracheal tube in the esophagus to provide a conduit for stomach content suction until definitive endotracheal intubation. We describe clinical circumstances in which we used this method successfully. Whether to leave the endotracheal tube in the esophagus or what to do with it should be specifically addressed in difficult airway algorithms.

Abstract 309: An Electromyographic System for Guiding Tracheal Intubation

Introduction: When tracheal intubation is necessary outside the hospital setting, inadvertent esophageal intubation may occur due to lower levels of provider experience and less access to equipment that can verify tracheal intubation. Therefore, we created a simple, rapid method for guiding endotracheal tube insertion. Methods: We constructed a system that can differentiate between the esophagus (smooth muscle tissue) and the trachea (nonmuscular tissue) based on electromyographic signal-response characteristics. We modified an endotracheal tube by adding 4 electrodes (2 for stimulating tissue with applied voltage and 2 for recording the tissue response) and tested the tube in a warm porcine model. We recorded 9 samples in 3 different locations in both the esophagus and the trachea, for a total of 18 samples. Both the stimulating voltage and the tissue response were recorded. We then used computational tools to analyze the resulting data and to create an integrative algorithm for differentiating between esophageal and tracheal tissue, based on the response signal. We differentiated the tissue types by using 3 integrated methods to measure 1) baseline frequency components to determine the average magnitude of contraction of the esophageal muscle tissue; 2) the rate of rectification of the response signal after the stimulation period; and 3) the difference between the average response voltages before and directly after stimulation. Results: The average magnitude of contraction was 24.3±13.7 V for esophageal tissue and 6.7±2.7 V for tracheal tissue ( P =0.013). The average rate of rectification of the response signal was 22.7±15.6 mV/sec for esophageal tissue and -0.177±8.35 mV/sec for tracheal tissue ( P =0.021). The difference between the average response voltages before and after stimulation was 2.89±1.84 mV for esophageal tissue and 0.834±0.930 mV for tracheal tissue ( P =0.023). By integrating these 3 methods, our algorithm had a sensitivity of 87.5% and specificity of 100%. Conclusion: With our system, rapid differentiation of the endotracheal-tube tip location provides real-time feedback information that may facilitate tube insertion into the trachea.

Two Complications of Tracheal Intubation in a Neonate

AN infant delivered in a private hospital after 33 weeks' gestation weighed 2,050 g, had persistent tachypnea, and had associated hypoxia requiring intubation. After three esophageal intubations, the neonate's trachea was successfully intubated. Despite mechanical ventilation, the infant had persistent tachycardia, hypoxemia (80–90% oxygen saturation) and a distended abdomen. A preoperative radiograph of this child shows the endotracheal tube tip in the right main bronchus (arrow A ), atelectasis of the entire left lung (arrow B ), pneumoperitoneum (white arrows ), and increased abdominal gas. At surgery, a 1.5-cm perforation of the anterior wall of the lesser curvature of the stomach was identified and repaired.The radiograph emphasizes critical complications that can occur during airway management of a neonate. Inadvertent esophageal intubation is one of the most common causes of neonatal intubation failure, which can lead to catastrophic consequences.1This condition can be rapidly detected by using end-tidal carbon dioxide monitoring, because it is the single most useful method in confirming endotracheal tube position.2In this neonate, gastric perforation likely occurred as a result of distension associated with positive pressure ventilation after esophageal intubation. Endobronchial intubation is another common problem associated with airway management in a neonate. This child's atelectasis likely developed after main stem intubation, when the endotracheal tube depth was noted to be 11 cm. As a guide to proper tracheal placement of an endotracheal tube, 1-, 2-, or 3-kg babies are intubated to a depth of 7, 8, or 9 cm, respectively.3These two complications reinforce the need for specialized training and experience in neonatal airway management.

Case report: Vibration response imaging findings following inadvertent esophageal intubation

We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI). Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally. This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation.

An assessment of a tracheal tube introducer as an endotracheal tube placement confirmation device

Introduction Early detection of an inadvertent esophageal intubation can be particularly challenging in cases when the current standard of care, carbon dioxide detection, is unreliable. We sought to determine the sensitivity and specificity of an inexpensive and portable device, the gum elastic bougie (Eschmann Tracheal Tube Introducer, SIMS Portex, Inc, Keene, NH), as an endotracheal tube placement confirmation device. Methods We conducted a prospective blinded trial in 20 human cadavers. Each cadaver was randomized to a mixed series of 5 esophageal and 5 tracheal intubations. Each intubation was assessed with the bougie twice, once by a novice to the technique, and once by an assessor who was constant through the trial. Assessors used the bougie to “feel” for “clicks” of the tracheal rings and to appreciate “hang up” of the bougie as it was advanced into the smaller airways. Absence of these findings was presumed to indicate an esophageal intubation. Actual placement was confirmed by bronchoscopy. Each assessor made an independent determination of tube location. Descriptive statistics were used to summarize the data. Results Overall, 93% (95% confidence interval [CI], 86%-97%) of tracheal placements were correctly identified. The constant assessor was able to correctly identify 98% (95% CI, 90%-100%). Tracheal rings were detected in 92% of tracheal placements. Ring clicks were 95% specific for tracheal intubation. Hang up was reported in 100% of tracheal placements with a specificity of 84%. Overall, 95% (95% CI, 88%-98%) of esophageal intubations were detected. The constant assessor detected 100% of esophageal intubations. Conclusion In the cadaver model used in this study, the gum elastic bougie (Eschmann Tracheal Tube Introducer) shows promise as an endotracheal tube confirmation device.

The Lost Endotracheal Tube

This case describes a previously unreported rare, but potentially disastrous, complication of endotracheal tube intubation initiated by prehospital emergency medical services personnel. This report details an inadvertent prehospital esophageal intubation and a critical error in communication between the prehospital and hospital service that resulted in failure to identify or remove the tube until after admission. The discussion includes complications of endotracheal tube intubation and esophageal foreign bodies. Proper communication between medical personnel is essential to reduce medical errors. Refraining from the use of slang terms may help prevent miscommunication between personnel upon transfer of patient care. This case shows the need be critical, observant, and wary at all times for even the most implausible findings in medicine.

Therapeutic hypothermia after prolonged cardiac arrest due to non-coronary causes

Mild resuscitative hypothermia has been shown to improve neurological outcome after cardiac arrest presenting with ventricular fibrillation (VF) due to cardiac causes. We describe the experience of inducing mild hypothermia in three patients with non-cardiac causes of arrest and long delays before a return of spontaneous circulation (ROSC). In one patient, extreme metabolic acidosis due to inadvertent oesophageal intubation complicated therapy, and the role of point-of-care diagnostics in the prehospital setting is briefly discussed. All patients survived to discharge from hospital, and neuropsychological examinations revealed good recovery. It is concluded that mild resuscitative hypothermia may be beneficial also in patients with obvious non-coronary causes for cardiac arrest.

Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation

This analysis primarily sought to determine the effectiveness of end-tidal capnography for tube placement confirmation during emergency airway management. Secondary objectives were validation of the rate of unanticipated esophageal placement during emergency intubation and quantification of the portion of intubations performed in patients with cardiac arrest where capnography is not recommended. The study was performed in two phases. For the primary objective, a meta-analysis was performed on all experimental capnography trials enrolling emergency populations. For the secondary objectives, inadvertent esophageal intubation and cardiac arrest rates were calculated from a large prospective multicenter observational study of emergency intubation cases. Data analysis included calculation of descriptive statistics, sensitivity, specificity, and confidence intervals (CI). Based on 2,192 intubations, a meta-analysis of previous capnography trials resulted in an aggregate sensitivity of 93% (95% CI 92–94%) and an aggregate specificity of 97% (CI 93–99%) for emergency tube placement confirmation. Thus, for emergency capnography use, the false-negative failure rate (tube in trachea but capnography reports esophagus) was 7% and the false-positive rate (tube in esophagus but capnography reports trachea) was 3%. This translates to potential harm for one patient in every 10 treated with capnographic confirmation alone (number needed to harm: 14 for false-negative, 33 for false-positive, and 10 for both). A further literature review demonstrated no sole method of tube placement confirmation is completely foolproof. Of 4,602 consecutive intubations reported to the National Emergency Airway Registry, 4% of emergency intubation attempts resulted in accidental esophageal intubation, and 10% occurred in nontraumatic cardiac arrest patients. During tracheal intubation of critically ill patients, it is concluded that the rate of accidental esophageal tube placement warrants continued improvement in emergency airway techniques. Misidentification of esophageal placement in the emergency setting may occur with capnography. Multiple methods of tube placement confirmation are superior to any single method because no single method has perfect accuracy.

Using the Toomey syringe as an oesophagal detector device

In this report we describe the negative-pressure or ‘Wee’ test for detection of inadvertent oesophageal intubation with reference to the published data on its reliability and potential problems. We also raise the possibility of using the readily available, low-cost 50 mL catheter-tipped (Toomey) syringe as an oesophageal-detector device and present the results of a pilot study into the feasibility of this variation. Given the high sensitivity and specificity of these techniques, their widespread use is encouraged.

Massive esophageal variceal hemorrhage triggered by complicated endotracheal intubation

Esophageal variceal hemorrhage is frequently a catastrophic event. The specific events that trigger variceal rupture are not well understood. Acute elevations in systemic blood pressure and increased splanchnic blood flow, however, may lead to increased intravariceal pressure followed by variceal rupture and hemorrhage. This report describes a strong temporal association between complicated endotracheal intubation and abrupt onset of life-threatening variceal hemorrhage. A 52-year-old man with a history of portal hypertension was intubated emergently for airway protection because of respiratory insufficiency due to sepsis. Intubation was complicated by initial inadvertent esophageal intubation and by a peak mean arterial blood pressure of 155 mmHg. At the conclusion of the procedure, the patient sustained large volume hematemesis due to esophageal variceal rupture. This case suggests a risk of triggering variceal hemorrhage as a result of intubation-induced increase in blood pressure. A number of agents, including fentanyl, have been shown to be effective in attenuating the cardiovascular response to intubation. This case report provides strong evidence in support of administering fentanyl, or a suitable alternative adjunctive medication, before intubation of patients with documented portal hypertension and a history of esophageal variceal hemorrhage.

Inadvertent Esophageal Intubation in the Field: Reliance on a Fool's “Gold Standard”

Academic Emergency MedicineVolume 4, Issue 2 p. 89-91 Free Access Inadvertent Esophageal Intubation in the Field: Reliance on a Fool's “Gold Standard” Steven J. White MD, Corresponding Author Steven J. White MD Vanderbilt University Medical Center, Nashville, TN, Department of Emergency Medicine, and Dr. White is at the Tennessee Department of Health, Division of Emergency Medical Services.Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232–4700. Fax: 615–936–1316; e-mail: steven.white@mcmail.vanderbilt.eduSearch for more papers by this authorCorey M. Slovis MD, Corresponding Author Corey M. Slovis MD Vanderbilt University Medical Center, Nashville, TN, Department of Emergency Medicine, and Dr. White is at the Tennessee Department of Health, Division of Emergency Medical Services.Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232–4700. Fax: 615–936–1316; e-mail: steven.white@mcmail.vanderbilt.eduSearch for more papers by this author Steven J. White MD, Corresponding Author Steven J. White MD Vanderbilt University Medical Center, Nashville, TN, Department of Emergency Medicine, and Dr. White is at the Tennessee Department of Health, Division of Emergency Medical Services.Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232–4700. Fax: 615–936–1316; e-mail: steven.white@mcmail.vanderbilt.eduSearch for more papers by this authorCorey M. Slovis MD, Corresponding Author Corey M. Slovis MD Vanderbilt University Medical Center, Nashville, TN, Department of Emergency Medicine, and Dr. White is at the Tennessee Department of Health, Division of Emergency Medical Services.Department of Emergency Medicine, Vanderbilt University Medical Center, 703 Oxford House, Nashville, TN 37232–4700. Fax: 615–936–1316; e-mail: steven.white@mcmail.vanderbilt.eduSearch for more papers by this author First published: 29 September 2008 https://doi.org/10.1111/j.1553-2712.1997.tb03711.xCitations: 32AboutPDF 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 onFacebookTwitterLinked InRedditWechat Citing Literature Volume4, Issue2February 1997Pages 89-91 ReferencesRelatedInformation

Delayed recognition of esophageal intubation in a neonate: Role of radiologic diagnosis

It is well known that inadvertent intubation of the esophagus can occur following attempted endotracheal intubation. In most cases, recognition is prompt and the problem is readily rectified. We present a case of delayed recognition of esophageal intubation in a neonate. This case was instructive to us because: a) it embarrassed the clinicians; and b) it demonstrated the possible role of radiologic diagnosis in inadvertent esophageal intubation.

Neural Network-Based Detection of Esophageal Intubation

To improve the accuracy of early detection of inadvertent esophageal intubation, we designed, trained, and tested a neural network-based computer system to detect the mechanical differences between lung and esophagogastric ventilation. Ten 25 to 30-kg anesthetized swine were sequentially ventilated with tidal volumes of 9, 12, and 15 mL/kg, using tubes placed in the trachea and in the esophagus, while flow and pressure waveforms were collected for 9-10 breaths. Gas remaining in the stomach was aspirated after each period of gastric ventilation. A computer program identified each mechanical inspiration, extracted the first 37 flow and pressure data points from each record, and normalized them to an equal amplitude. A back-propagation single-hidden-layer neural network was trained to identify the origin of flow and pressure waveforms as tracheal or esophageal. Ten different training and testing groups were assembled. In each group, data from nine subjects were used for training and data from the remaining subjects were used for testing. A total of 291 esophageal and 300 tracheal flow and pressure waveforms were analyzed by the network. The network identified esophageal intubation correctly during the first five breaths of all esophageal recordings. In one subject, the network identified the eighth esophageal breath as tracheal and could not identify three breaths. All tracheal intubations were identified correctly. Flow and pressure "signatures" of pulmonary and gastric ventilation are easily learned by a neural network. Therefore, neural-network recognition of esophageal intubation from flow and pressure signals is possible, and the development of an on-line detector for tracheal tube misplacement seems feasible.

Efficacy of the FEF Colorimetric End-Tidal Carbon Dioxide Detector in Children

Direct laryngoscopy and observation of endotracheal tube (ETT) passage between the vocal cords remain the criterion standard for verifying endotracheal intubation. Detection of end-tidal carbon dioxide (ETCO2) serves as an invaluable adjunct to confirm endotracheal intubation, detect inadvertent esophageal intubation, and monitor for accidental tracheal extubation. Capnography, however, is often unavailable outside the operating suite. A commercially available, disposable, colorimetric ETCO2 detector (FEF, Fenem, Inc., New York, N.Y.), in which color changes using a numerical scale semiquantitatively measure percent carbon dioxide in exhaled gases, has proved effective in confirming endotracheal intubation in adults, but has not been thoroughly investigated in children. We studied 20 otherwise healthy children, aged 6 mo to 8 yr, with simultaneous infrared and colorimetric ETCO2 measurements during elective general anesthesia to evaluate the efficacy of the colorimetric detector. Two hundred of 200 tracheally intubated positive-pressure breaths and 198 of 200 breaths under spontaneous mask ventilation demonstrated a yellow color change (color level 5 or 6), signifying an ETCO2 greater than or equal to 15 mm Hg (2.0 kPa). Repeated-measures analysis of variance revealed no significant differences in infrared ETCO2 values between the two yellow color levels throughout the study period. The associations among color level, infrared ETCO2 determinations, ETT size, and ETT "leak" pressures estimated by Spearman rank correlation analysis were significant only for higher infrared ETCO2 values with higher ETT leak pressures (P less than 0.05). No complications were observed. The Fenem disposable colorimetric ETCO2 detector effectively confirms clinical signs of endotracheal intubation in children when capnography is unavailable.(ABSTRACT TRUNCATED AT 250 WORDS)

Early Detection of Inadvertent Esophageal Intubation

Early Detection of Inadvertent Esophageal Intubation