Confirmation of endotracheal tube position: A narrative review

Praveen Rudraraju, Lewis Eisen

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. Strengths and weaknesses of particular methods are highlighted. Although many physical examination maneuvers have been described, reliance on the physical examination alone is insufficient for confirmation. Touted methods that appear failsafe, such as direct visualization of the ETT traversing the vocal cords have limitations, especially when dealing in the emergency setting accompanying a difficult to visualize airway. While carbon dioxide detection is an excellent confirmatory method, it is not infallible. Esophageal detection devices are useful as an alternative means of confirmation. New methods such as ultrasonic location of the ETT show promise but require further study. The clinician performing ETT insertion should have multiple confirmation methods that allow the practitioner to adapt to a variety of clinical situations, depending on local costs and availability. Finally, when the clinician still has uncertainty, or multiple tests give conflicting results, the availability of bronchoscopy at the bedside to visualize the carina through the ETT is useful.

Original languageEnglish (US)
Pages (from-to)283-292
Number of pages10
JournalJournal of Intensive Care Medicine
Volume24
Issue number5
DOIs
StatePublished - Sep 2009

Fingerprint

Physical Examination
Airway Management
Vocal Cords
Bronchoscopy
Electric Impedance
Intubation
Critical Illness
Ultrasonics
Carbon Dioxide
Uncertainty
Emergencies
Technology
Costs and Cost Analysis
Equipment and Supplies

Keywords

  • Auscultation
  • Carbon dioxide/analysis
  • Critical care
  • Intratracheal
  • Intubation
  • Oximetry

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Confirmation of endotracheal tube position : A narrative review. / Rudraraju, Praveen; Eisen, Lewis.

In: Journal of Intensive Care Medicine, Vol. 24, No. 5, 09.2009, p. 283-292.

Research output: Contribution to journalArticle

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