Abstract
Background: Endotracheal tube (ETT) malpositionis common but rapid identification of exact positionof the tube is difficult at the bedside.
Aim: To compare six different potential bedsideindicators of ETT malposition in a piglet model ofneonatal lung injury.
Methods: Six anaesthetised and muscle-relaxedpiglets with saline lavaged surfactant-deficientlungs (AaDO2>350mmHg in FIO21.0) conventionallyventilated were studied. Transient periods (30-120s)of ventilation with the ETT place in the oesophagusand a single main bronchus (MB) were comparedwith an appropriately placed ETT. During eachperiod, colorimetric end-tidal CO2(Pedi-Cap®), flowat the airway opening (Florian), global/regional lungvolume and tidal ventilation (electrical impedancetomography; EIT), SpO2 and heart rate werecontinuously measured.
Results: Compared to ventilation via a correct placedETT; Oesophageal ventilation: SpO2 decreased from96% to 74%, without heart rate change. Pedi-Cap®demonstrated absence of tidal color change, andno expired tidal volume was seen on the Florian. EIT confirmed absence of any lung inflation.
MB ventilation: There was no significant differencebetween the SpO2, heart rate, Pedi-Cap® and peakinspiratory/expiratory tidal flows, EIT demonstrateda significant change in tidal volume ventilation with97% occurring in the ventilated lung and 3% in theunventilated lung.
Conclusion: The Pedi-Cap and RFM were able todistinguish between endotracheal and oesophagealventilation. EIT alone correctly identified all adverseevents and might have a role in bedside monitoringof ventilated infants.
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Schmölzer, G., Bhatia, R., Davis, P. et al. 1331 A Comparison of Different Bedside Techniques of Determining Endotracheal Tube Malposition. Pediatr Res 68 (Suppl 1), 658–659 (2010). https://doi.org/10.1203/00006450-201011001-01331
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DOI: https://doi.org/10.1203/00006450-201011001-01331