A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model1. Issue 2 (21st May 2012)

• Record Type: Journal Article
• Authors: Schmölzer, Georg M.; Bhatia, Risha; Davis, Peter G.; Tingay, David G.
• Is Part Of: Pediatric pulmonology. Volume 48:Issue 2(2013:Feb.)
• Page Start: 138
• Page End: 145
• Publication Date: 2012-05-21
• Subjects: Pediatric respiratory diseases -- Periodicals; Pediatrics -- Periodicals; 618.922
• DOI: 10.1002/ppul.22580
• Languages: English
• ISSNs: 8755-6863

Abstract

<abstract abstract-type="main" xml:lang="en"> <title>Abstract</title> <sec id="abs1-1" sec-type="section"> <title>Rationale</title> <p>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.</p> </sec> <sec id="abs1-2" sec-type="section"> <title>Objective</title> <p>This study aimed to compare EIT with five other non‐invasive techniques for identifying ETT position in a piglet model.</p> </sec> <sec id="abs1-3" sec-type="section"> <title>Methodology</title> <p>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<sub>2</sub> (Pedi‐Cap®), SpO<sub>2</sub> and heart rate, tidal volume (<tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm ao}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3gg" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" />) using a hot‐wire anemometer at the airway opening, tidal volume using respiratory inductive plethysmography (<tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm RIP}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3z6" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" />) and regional tidal ventilation within each hemithorax (EIT) were measured.</p> </sec> <sec id="abs1-4" sec-type="section"> <title>Results</title> <p> <italic>Oesophageal ventilation</italic>: Pedi‐Cap® demonstrated absence of color change. <tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm ao}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3xn" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" />, <tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm RIP}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3w3" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" />, and EIT correctly demonstrated no tidal ventilation. SpO<sub>2</sub> decreased from mean (SD) 96 (2)% to 74 (12)% (<italic>P</italic> < 0.05; Bonferroni post‐test), without heart rate change. <italic>MB ventilation:</italic> SpO<sub>2</sub>, heart rate and Pedi‐Cap® were unchanged compared with mid‐tracheal position. <tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm ao}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3vj" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /> and <tex-math notation="tex"><![CDATA[${\rm V}_{{\rm T}_{{\rm RIP}} } $]]></tex-math><inline-graphic xlink:href="ark:/27927/pgg1q9kw3t0" mimetype="image" xlink:type="simple" xmlns:xlink="http://www.w3.org/1999/xlink" /> 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 <italic>P</italic> < 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.</p> </sec> <sec id="abs1-5" sec-type="section"> <title>Conclusions</title> <p>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. Pediatr Pulmonol. 2013; 48:138–145. © 2012 Wiley Periodicals, Inc.</p> </sec> </abstract>