Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions.

STUDY OBJECTIVE

To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions.

DESIGN

Prospective crossover study.

SETTING

University-affiliated hospital.

PATIENTS

44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures.

INTERVENTIONS

ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement.

MEASUREMENTS

The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning.

MAIN RESULTS

FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range" positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery.

CONCLUSIONS

Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions.