Chest radiography after endotracheal tube placement: is it necessary or not?

Misplacement of Tracheostomy Tube in the Right Main Bronchus: a Rare Complication

“…Post intubation CXR seems to be limited to patients undergoing technically problematic and complicated procedures. Based on the incidence of malpositioned tubes, post endotracheal intubation chest radiography is supported by numerous studies [5][6][7][8][9]. The recommendation for routine CXR after tracheostomy is indeed controversial in uncomplicated tracheostomy placement; however, when there is a difficulty due to anatomic variance, tumor, or revisions, then CXR is certainly beneficial to confirm appropriate tube placement.…”

Back to Basics: Endotracheal Tube Too Deep, Too Shallow, Then Just Right

“…Thus, radiographic confirmation is important. Indeed, an emergency department study of more than 380 patients concluded that while ED intubations have high success rates, the complications of inappropriate intubations are high stakes enough that post-intubation CXR remains a necessary step to minimize the incorrect placement of the tube [ 5 ]. A similar study performed in the intensive care unit (ICU) on over 200 patients concluded the same [ 6 ].…”

Inadvertent Endobronchial Intubation in a Patient With a Short Neck Length

“…Chest radiography has been recommended to confirm proper endotracheal tube placement. 4,8 However, we feel that chest radiography is expensive and time consuming and should be reserved for cases, such as the one discussed in this study, where anatomical variation or other complicating factors cast doubt on the proper placement of the endotracheal tube. A flexible fiber-optic scope inserted into the tube to observe where the tip of the tube is located is an excellent alternative technique to determine proper placement above the carina.…”

“…2,10 In order for bilateral breath sounds to be properly confirmed, 5 foci must be auscultated: bilateral axillae, bilateral fifth intercostal spaces, and the epigastrium. 4 Many authors have shown that effective lung auscultation is highly skill dependent and can be misleading nearly two thirds of the time. 2,12,13 The use of endotracheal tubes with a Murphy eye can result in bilateral breath sounds in 48% of patients who have an esophageal intubation and in 60% of patients who have a main-stem intubation.…”

“…4 Right bronchial intubation, or main-stem intubation, has been shown to occur in up to 5-28% of intubation attempts and accounts for 2% of adverse respiratory claims in adults and 4% in children. [5][6][7][8] If left uncorrected, main-stem intubation can result in overinflation of the intubated lung and partial to complete atelectasis of the contralateral lung.…”