Techniques to ascertain correct endotracheal tube placement in neonates

Schmölzer, Georg M.; Roehr, Charles Christoph

doi:10.1002/14651858.cd010221.pub3

Cited by 12 publications

(19 citation statements)

References 33 publications

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“…The neonatal larynx is highly positioned between C3 and C5, while carina is usually at the level of T4 . Thus, the mid‐carina correct position is somewhere between T1 and T2 . It has been reported that if the correct mid‐trachea position is achieved, neck movements do not significantly influence a safe and correct tube position .…”

Section: Discussionmentioning

confidence: 99%

“…Although a postintubation chest X‐ray is usually performed to assess the correct endotracheal tube (ETT) placement , its execution might be demanding during critical care transport. In the absence of radiological images to confirm the ETT position within the trachea, a reliable nomogram of tube depth and an accurate assessment of clinical signs after intubation are of paramount importance to ensure an effective respiratory support during transport .…”

Section: Introductionmentioning

confidence: 99%

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Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting

et al. 2018

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“…Two small studies in NICU and the delivery suite found that continuous waveform capnography accurately predicted oesophageal intubation and reduced the time taken to detect this . However, many clinicians have concerns regarding continuous capnography monitoring for four reasons: first, a 2014 Cochrane review concluded that there was insufficient evidence to determine the most effective technique for assessing tracheal tube placement in neonates ; second, continuous capnography monitoring may cause auto‐triggering of the ventilator ; third, continuous capnography monitoring added extra weight to the breathing system, which could lead to accidental tracheal extubation ; fourth, capnography monitoring is associated with an increase in dead space . Such opinions were borne out by this survey, with only 18% of NICUs always having capnography available, and just 8% always using continuous capnography for babies whose tracheas are intubated and who are ventilator dependent.…”

Section: Discussionmentioning

confidence: 99%

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey

et al. 2018

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In 2011, the Fourth National Audit Project (NAP4) reported high rates of airway complications in adult intensive care units (ICUs), including death or brain injury, and recommended preparation for airway difficulty, immediately available difficult airway equipment and routine use of waveform capnography monitoring. More than 80% of UK adult intensive care units have subsequently changed practice. Undetected oesophageal intubation has recently been listed as a 'Never Event' in UK practice, with capnography mandated. We investigated whether the NAP4 recommendations have been embedded into paediatric and neonatal intensive care practice by conducting a telephone survey of senior medical or nursing staff in UK paediatric intensive care units (PICUs) and neonatal intensive care units (NICUs). Response rates were 100% for paediatric intensive care units and 90% for neonatal intensive care units. A difficult airway policy existed in 67% of paediatric intensive care units and in 40% of neonatal intensive care units; a pre-intubation checklist was used in 70% of paediatric intensive care units and in 42% of neonatal intensive care units; a difficult intubation trolley was present in 96% of paediatric intensive care units and in 50% of neonatal intensive care units; a videolaryngoscope was available in 55% of paediatric intensive care units and in 29% of neonatal intensive care units; capnography was 'available' in 100% of paediatric intensive care units and in 46% of neonatal intensive care units, and 'always available' in 100% of paediatric intensive care units and in 18% of neonatal intensive care units. Death or serious harm occurring secondary to complications of airway management in the last 5 years was reported in 19% of paediatric intensive care units and in 26% of neonatal intensive care units. We conclude that major gaps in optimal airway management provision exist in UK paediatric intensive care units and especially in UK neonatal intensive care units. Wider implementation of waveform capnography is necessary to ensure compliance with the new 'Never Event' and has the potential to improve airway management.

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“…Carbon dioxide (CO 2 ) levels are good indicators of efficacy in gas exchange [68], and for this reason, colourimetric CO 2 detector is currently used to detect the correct placement of the endotracheal tube [69][70][71].…”

Section: Monitoring During Neonatal Transitionmentioning

confidence: 99%

Respiratory Distress Syndrome Management in Delivery Room

Lista¹,

Schmölzer²,

Bresesti³

2018

Pregnancy and Birth Outcomes

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The proper management of respiratory distress syndrome in the delivery room is a crucial step in the transition to extrauterine life, especially for preterm infants. In fact, it has been widely established that the optimization of the cardiovascular and the respiratory changes, which normally happen as soon as a term healthy baby is delivered, can have long-term effects. For this reason, every clinician approaching the delivery room should be aware of the consequences an inappropriate management could lead to and should know how to perform a proper resuscitation, using, where available, the most recent techniques. Regardless of the level of care provided by the hospital, there are some key interventions, which can be applied easily in every setting and are of crucial importance. In this chapter, we aim to provide a comprehensive overview of the most relevant measures to manage respiratory distress syndrome from the delivery room, starting from an explanation of the disease and moving toward the most recent evidence, from the basic concepts to the most advanced techniques to monitor fetal-neonatal transition.

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Techniques to ascertain correct endotracheal tube placement in neonates

Abstract: The editorial group responsible for this previously published document have withdrawn it from publication.

Cited by 12 publications

References 33 publications

Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting

Development of a novel reference nomogram for endotracheal intubation in neonatal emergency transport setting

Paediatric intensive care and neonatal intensive care airway management in the United Kingdom: the PIC‐NIC survey

Respiratory Distress Syndrome Management in Delivery Room

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