Radiological validation of tracheal tube insertion depth in out‐of‐hospital and in‐hospital emergency patients

Abstract

SummaryWe performed a 5-year, retrospective study using records of 1081 patients admitted to the trauma emergency room at a University Hospital to investigate the occurrence of tracheal tube malpositioning after emergency intubation in both the inpatient and outpatient settings, using chest radiographs and CT scans in the trauma emergency room. Prehospital patients and inpatients referred from peripheral hospitals were compared. This study showed that tracheal tube misplacements occur with an incidence of 18.2%, of which almost a third (5.7%) were placed in a main bronchus. We further show that tracheal intubation in emergency patients approximates the misplacement rates in the prehospital or in-hospital settings. We speculate that the skill level of the operator may be critical in determining the success of tracheal intubation. Based on our findings, all efforts should be made to verify the tube position with immediate radiographic confirmation after admission to the emergency room.

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.…”

“…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. 9 Secondary complications can result in hypoxemia, barotrauma, cardiac arrhythmias, hypotension, or tension pneumothorax.…”

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.…”

Inflating the endotracheal tube cuff with saline to confirm correct depth using bedside ultrasonography

“…33,34 Inadvertent endobronchial intubation is associated with serious complications, such as hypoxemia and …”