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Reddy AA, Ayyan SM, Anandhi D, Ganessane E, Amrithanand VT. Bed-up-head-elevated Position versus Supine Sniffing Position in Patients Undergoing Rapid Sequence Intubation Using Direct Laryngoscopy in the Emergency Department - A Randomized Controlled Trial. J Emerg Trauma Shock 2024; 17:58-65. [PMID: 39070859 PMCID: PMC11279501 DOI: 10.4103/jets.jets_109_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/14/2024] [Accepted: 02/02/2024] [Indexed: 07/30/2024] Open
Abstract
Introduction The objective of this study is to compare bed-up-head-elevated (BUHE) position with supine sniffing position (SSP) in patients undergoing rapid sequence intubation (RSI) using direct laryngoscopy in the emergency department (ED). Methods This single-center randomized controlled superiority trial was carried out from September 2021 to December 2022 in an academic emergency medicine department. The patients undergoing RSI in ED were grouped into two arms, namely BUHE position and SSP. The primary outcome was the time taken for endotracheal intubation. The secondary outcomes were the first-pass success rates and postintubation complications. Results A total of 136 patients were enrolled in the study. Time for intubation in the BUHE group was no different from SSP (32.09 s [interquartile range (IQR): 23.30-42.68] vs. 33.40 [IQR: 27.53-45.90], P = 0.17). There was a modest reduction in intubation time when performed by trained experts (22.5 s [IQR: 17.7-25.3] versus 30.3 s [IQR: 21.3-33.2], P = 0.04). The first-attempt success rate in the BUHE position was also similar to the SSP position ([91.18% vs. 90.91%] P = 0.958). Postintubation complications were lesser in BUHE compared to the SSP group ([7.4% vs. 19.7%] P = 0.04). Conclusions In our study, BUHE position did not improve time to intubation and first-pass success rate in ED patients compared to SSP. A modest decrease in intubation time was noted while experts used the BUHE position. The postintubation complications were slightly lesser in the BUHE group.
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Affiliation(s)
- Admala Anudeep Reddy
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - S. Manu Ayyan
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - D. Anandhi
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Ezhilkugan Ganessane
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - V. T. Amrithanand
- Department of Emergency Medicine and Trauma, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Voucharas C, Tagarakis G, Vouchara A. Unexpected Lung Collapse Following Chest Tube Insertion for Pneumothorax Drainage in an Intubated Patient Due to Dislocation of the Endotracheal Tube. Cureus 2024; 16:e55236. [PMID: 38558624 PMCID: PMC10981442 DOI: 10.7759/cureus.55236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
A 67-year-old male patient was admitted to the intensive care unit following an uncomplicated heart operation. The initial postoperative chest X-ray revealed a total pneumothorax on the left side. Despite drainage of the left pleural space, a subsequent chest X-ray unexpectedly showed opacification of the left hemithorax. Partial withdrawal of the endotracheal tube resulted in complete expansion of the left lung. It is important to always consider the possibility of endotracheal tube dislocation in all intubated patients.
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Affiliation(s)
- Christos Voucharas
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Georgios Tagarakis
- Department of Cardiothoracic Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Angeliki Vouchara
- Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
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Kim H, Yoon HK, Lee H, Jung CW, Lee HC. Predicting optimal endotracheal tube size and depth in pediatric patients using demographic data and machine learning techniques. Korean J Anesthesiol 2023; 76:540-549. [PMID: 37750295 PMCID: PMC10718635 DOI: 10.4097/kja.23501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/13/2023] [Accepted: 09/26/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Use of endotracheal tubes (ETTs) with appropriate size and depth can help minimize intubation-related complications in pediatric patients. Existing age-based formulae for selecting the optimal ETT size present several inaccuracies. We developed a machine learning model that predicts the optimal size and depth of ETTs in pediatric patients using demographic data, enabling clinical applications. METHODS Data from 37,057 patients younger than 12 years who underwent general anesthesia with endotracheal intubation were retrospectively analyzed. Gradient boosted regression tree (GBRT) model was developed and compared with traditional age-based formulae. RESULTS The GBRT model demonstrated the highest macro-averaged F1 scores of 0.502 (95% CI 0.486, 0.568) and 0.669 (95% CI 0.640, 0.694) for predicting the uncuffed and cuffed ETT size (internal diameter [ID]), outperforming the age-based formulae that yielded 0.163 (95% CI 0.140, 0.196, P < 0.001) and 0.392 (95% CI 0.378, 0.406, P < 0.001), respectively. In predicting the ETT depth (distance from tip to lip corner), the GBRT model showed the lowest mean absolute error (MAE) of 0.71 cm (95% CI 0.69, 0.72) and 0.72 cm (95% CI 0.70, 0.74) compared to the age-based formulae that showed an error of 1.18 cm (95% CI 1.16, 1.20, P < 0.001) and 1.34 cm (95% CI 1.31, 1.38, P < 0.001) for uncuffed and cuffed ETT, respectively. CONCLUSIONS The GBRT model using only demographic data accurately predicted the ETT size and depth. If these results are validated, the model may be practical for predicting optimal ETT size and depth for pediatric patients.
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Affiliation(s)
- Hyeonsik Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyeonhoon Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Chul-Woo Jung
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea
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Burnhill G, Henshaw J, Lapitan S, Benson L, Lillie J. A Bedside Equation to Estimate Endotracheal Tube Length for Infants. J Pediatr 2023; 260:113476. [PMID: 37182663 DOI: 10.1016/j.jpeds.2023.113476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/15/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To develop a bedside equation that can be used to estimate the ideal oral and nasal endotracheal tube (ETT) length for children younger than 1 year of age. STUDY DESIGN Retrospective database analysis of 735 children younger than 1 year of age admitted to pediatric intensive care at Evelina London Children's Hospital from June 1, 2019, through August 31, 2021. ETT positions were determined by tube-tip superimposition over vertebral body on postintubation chest radiograph by trained medical students and pediatric radiologists with bedside assessment of ETT length at nostril or lip as recorded electronically by nursing staff. RESULTS The position of 1176 ETTs were evaluated, of which 784 (66%) were nasal and 392 (33%) were oral. After averaging length to account for multiple intubation events per patient, 281 (39%) nasal tubes and 105 (28%) oral tubes were found to be positioned optimally at T2. Using weight was superior to age or corrected age at estimating ETT length. Regression analysis revealed that optimal (T2) positioning of oral ETTs occurs at a length of (weight2+8) cm and in nasal ETTs at (weight2+9.5) cm with a mean absolute prediction error of 5%. The formulae did not require adjustments for those with comorbidities or prematurity. CONCLUSIONS The optimal insertion length of ETTs placed both orally and nasally in children up to 1 year of age can be estimated with appropriate accuracy by a simple bedside formula using weight as the only variable.
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Affiliation(s)
- Geoff Burnhill
- Paediatric Intensive Care Department, Evelina London Children's Hospital, London, United Kingdom
| | - Jack Henshaw
- King's College London University, London, United Kingdom
| | | | - Louis Benson
- King's College London University, London, United Kingdom
| | - Jon Lillie
- Paediatric Intensive Care Department, Evelina London Children's Hospital, London, United Kingdom; King's College London University, London, United Kingdom.
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Miller KA, Goldman MP, Nagler J. Management of the Difficult Airway. Pediatr Emerg Care 2023; 39:192-200. [PMID: 36790950 DOI: 10.1097/pec.0000000000002916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
ABSTRACT Airway management is a fundamental component of care during resuscitation of critically ill and injured children. In addition to predicted anatomic and physiologic differences in children compared with adults, certain conditions can predict potential difficulty during pediatric airway management. This review presents approaches to identifying pediatric patients in whom airway management is more likely to be difficult, and discusses strategies to address such challenges. These strategies include optimization of effective bag-mask ventilation, alternative approaches to laryngoscopy, use of adjunct airway devices, modifications to rapid sequence intubation, and performance of surgical airways in children. The importance of considering systems of care in preparing for potentially difficult pediatric airways is also discussed.
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Affiliation(s)
- Kelsey A Miller
- From the Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Michael P Goldman
- Section of Pediatric Emergency Medicine, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, CT
| | - Joshua Nagler
- From the Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA
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Tracheal Tube Misplacement after Emergency Intubation in Pediatric Trauma Patients: A Retrospective, Exploratory Study. CHILDREN 2022; 9:children9020289. [PMID: 35205009 PMCID: PMC8870798 DOI: 10.3390/children9020289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/14/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023]
Abstract
Inadvertent tracheal tube misplacement and particularly endobronchial intubation are well-known complications of emergency endotracheal intubation (ETI) in pediatric trauma patients, which require repositioning of the tube to avoid impairment of gas exchange. The main aim of study was to identify the frequency of tube misplacement and associated factors of pediatric trauma patients who received ETI either by prehospital physician-staffed emergency medical service (EMS), or at emergency department (ED) admission to a single level-1 trauma center. Sixty-five patients (median age 14 years and median injury severity score 29) were included. Of these, 30 underwent helicopter EMS ETI, 29 ground EMS ETI, and 6 ED ETI. Seventeen cases (26%) of tracheal tube misplacement were recognized. After multivariable analysis, tracheal tube misplacement was independently negatively associated with body weight (OR 0.86; 95% CI, 0.76–0.99; p = 0.032) and helicopter EMS ETI (OR 0.20; 95% CI, 0.04–0.97; p = 0.036). Two of nineteen patients received tube thoracostomy due to endobronchial intubation. Mortality and length of stay were comparable in patients with misplaced tubes and correctly placed tubes. The results suggest that particularly small children require attention to avoid tracheal tube misplacement, which emphasizes the need for special training. Helicopter EMS physicians’ expertise might be beneficial in prehospital pediatric trauma patients requiring advanced airway management.
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Kei J, Mebust DP. Effects of cardiopulmonary resuscitation on direct versus video laryngoscopy using a mannequin model. Am J Emerg Med 2021; 50:587-591. [PMID: 34563941 DOI: 10.1016/j.ajem.2021.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION During the last decade, guidelines for cardiopulmonary resuscitation has shifted, placing chest compressions and defibrillation first and airway management second. Physicians are being forced to intubate simultaneously with uninterrupted, high quality chest compressions. Using a mannequin model, this study examines the differences between direct and video laryngoscopy, comparing their performance with and without simultaneous chest compressions. METHODS Fifty emergency medicine physicians were randomly assigned to intubate a mannequin six times, using direct laryngoscopy (DL) and with two video laryngoscopy (VL) systems, a C-MAC traditional Macintosh blade and a GlideScope hyperangulated blade, with and without simultaneous chest compressions. A total of 300 intubations were completed and variables including intubation times, accuracy, difficulty, success rates and glottic views were recorded. RESULTS The C-MAC VL system resulted in quicker intubations compared to DL (p = 0.007) and the GlideScope VL system (p = 0.039) during active chest compressions. Compared to DL, intubations were rated easier for both the C-MAC (p < 0.0001) and the GlideScope (p < 0.0001). Intubation failure rates were also higher when DL was used compared to either the C-MAC or GlideScope (p = 0.029). VL devices provided a superior overall Cormack-Lehane grade view compared to DL (p < 0.0001). The presence of chest compressions significantly impaired Cormack-Lehane views during direct laryngoscopy (p = 0.007). Chest compressions made the intubation more difficult under DL (p = 0.002) and when using the C-MAC (p = 0.031). Chest compressions also made ETT placement less accurate when using DL (p = 0.004). CONCLUSION Using a mannequin model, the C-MAC conventional VL blade resulted in decrease intubation times compared with DL or the GlideScope hyperangulated VL blade system. Overall, VL out performed DL in terms of providing a superior glottic view, minimizing failed attempts, and improving physician's overall perception of intubation difficulty. Chest compressions resulted in worse Cormack-Lehane views and higher rates of inaccurate endotracheal tube placement with DL, compared to VL.
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Affiliation(s)
- Jonathan Kei
- Kaiser Permanente Medical Center, Department of Emergency Medicine, 4647 Zion Ave., San Diego, CA 92120, United States of America.
| | - Donald P Mebust
- Kaiser Permanente Medical Center, Department of Emergency Medicine, 4647 Zion Ave., San Diego, CA 92120, United States of America
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Miller KA, Monuteaux MC, Nagler J. Technical factors associated with first-pass success during endotracheal intubation in children: analysis of videolaryngoscopy recordings. Emerg Med J 2020; 38:125-131. [PMID: 33172879 DOI: 10.1136/emermed-2020-209700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 09/16/2020] [Accepted: 10/04/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND First-pass success (FPS) during intubation is associated with lower morbidity for paediatric patients. Using videolaryngoscopy (VL) recordings, we reviewed technical aspects of intubation, including factors associated with FPS in children. METHODS We performed a retrospective study of intubation attempts performed using video-assisted laryngoscopy in a paediatric ED between January 2014 and December 2018. Data were abstracted from a quality assurance database, the electronic medical record and VL recordings. Our primary outcome was FPS. Intubation practices were analysed using descriptive statistics. Patient and procedural characteristics associated with FPS in univariate testing and clinical factors identified from the literature were included as covariates in a multivariable logistic regression. An exploratory analysis examined the relationship between position of the glottic opening on the video screen and FPS. RESULTS Intubation was performed during 237 patient encounters, with 231 using video-assisted laryngoscopy. Data from complete video recordings were available for 129 attempts (59%); an additional 31 (13%) had partial recordings. Overall, 173 (73%) of first attempts were successful. Adjusting for patient age, placing the blade tip into the vallecula adjusted OR ((aOR) 7.2 (95% CI 1.7 to 30.1)) and obtaining a grade 1 or 2a-modified Cormack-Lehane glottic view on the videolaryngoscope screen (aOR 6.1 (95% CI 1.5 to 25.7) relative to grade 2b) were associated with increased FPS in the subset of patients with complete recordings. Exploratory analysis suggested that FPS is highest (81%) and duration is shortest when the glottic opening is located in the second quintile of the video screen. CONCLUSIONS Placement of the blade tip into the vallecula regardless of blade type, sufficient glottic visualisation and locating the glottic opening within the second quintile of the video screen were associated with FPS using video-assisted laryngoscopy in the paediatric ED.
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Affiliation(s)
- Kelsey A Miller
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA .,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael C Monuteaux
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua Nagler
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Assessment of Nonroutine Events During Intubation After Pediatric Trauma. J Surg Res 2020; 259:276-283. [PMID: 33138986 DOI: 10.1016/j.jss.2020.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 08/28/2020] [Accepted: 09/22/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Intubation in the early postinjury phase can be a high-risk procedure associated with an increased risk of mortality when delayed. Nonroutine events (NREs) are workflow disruptions that can be latent safety threats in high-risk settings and may contribute to adverse outcomes. MATERIALS AND METHODS We reviewed videos of intubations of injured children (age<17 y old) in the emergency department occurring between 2014 and 2018 to identify NREs occurring between the decision to intubate and successful intubation ("critical window"). RESULTS Among 34 children requiring intubation, the indications included GCS≤8 (n = 20, 58.8%), cardiac arrest (n = 6, 17.6%), airway protection (n = 5, 14.7%), and respiratory failure (n = 3, 8.8%). The median duration of the "critical window" was 7.5 min (range 1.4-27.5 min), with a median of six NREs per case in this period (range 2-30). Most NREs (n = 159, 61.9%) delayed workflow, with 31 (12.1%) of these delays each lasting more than one minute. Eighty-seven NREs (33.9%) had a potential for harm but did not lead to direct patient harm. The most common NREs directly related to the intubation process were poor positioning for intubation (n = 23, 8.9%) and difficulty passing the endotracheal tube (n = 5, 1.9%), with most being attributed to the anesthesiologist performing the intubation (n = 51, range 0-7). CONCLUSIONS Workflow disruptions related to nonroutine events were frequent during pediatric trauma intubation and were often associated with delays and potential for patient harm. Interventions for improving the efficiency and timeliness of the critical window should focus on adherence to intubation protocol and improving communication and teamwork related to tasks in this phase.
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Ebenebe CU, Deindl P, Wolf M, Jahn M, Singer D, Blohm ME. A prospective observational trial evaluating factors predictive of accurate endotracheal tube positioning in neonates and small infants. Paediatr Anaesth 2020; 30:922-927. [PMID: 32634269 DOI: 10.1111/pan.13965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/15/2020] [Accepted: 06/27/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a high incidence of endotracheal tube malposition in neonates and small infants. Yet, verification of accurate endotracheal tube location via radiographic imaging involves radiation exposure. AIMS This study aimed to identify demographic and clinical parameters associated with accurate endotracheal tube positioning. METHODS We conducted a prospective single-center study with term and preterm neonates and small infants between January 2018 and November 2019. We investigated correlations between ten variables and accurate endotracheal tube position. RESULTS One hundred and sixty eight nasal intubations in 139 patients (weight 390-5000 g) were analyzed. An accurate tube position was confirmed by radiographic imaging in 71.4% of the intubations. The endotracheal tube was high in 8.3% and low in 20.2% of the cases. Male gender was the only variable that significantly correlated with an accurate endotracheal tube position (OR 2.5; 95% CI: 1.3, 5.0; P = .010). CONCLUSION So far, no parameter has proven to be able to predict accurate endotracheal tube position in neonates reliably. These findings emphasize the indispensability of postintubation imaging in neonates and small infants.
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Affiliation(s)
- Chinedu Ulrich Ebenebe
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Deindl
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Wolf
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias Jahn
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dominique Singer
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Ernst Blohm
- Division of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Santos DLS, Andrade PDDO, Gomes ELDFD. Does the endotracheal tube insertion depth predicted by formulas in children have a good concordance with the ideal position observed by X-ray? Rev Bras Ter Intensiva 2020; 32:295-300. [PMID: 32667431 PMCID: PMC7405750 DOI: 10.5935/0103-507x.20200046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 02/10/2020] [Indexed: 11/26/2022] Open
Abstract
Objective To evaluate the effectiveness of the different formulas for estimating the insertion depth of an endotracheal tube in children. Methods This was an observational and cross-sectional study that included children between 29 days and 2 years of age who were hospitalized in a pediatric intensive care unit and mechanically ventilated. The formulas based on height [(height/10) + 5], the inner diameter of the tube (endotracheal tube × 3), and weight (weight + 6) were evaluated to determine which of them showed better concordance with the ideal insertion depth of the endotracheal tube as evaluated by X-ray. Results The correlation between the height-based calculation and the ideal depth observed on X-ray was strong, with r = 0.88, p < 0.05, and a concordance correlation coefficient of 0.88; the correlation between the weight-based calculation and depth on X-ray was r = 0.75, p < 0.05, and concordance correlation coefficient 0.43; and the correlation between endotracheal tube diameter-based calculation and depth on X-ray was r = 0.80, p < 0.05, and concordance correlation coefficient 0.78. Lin’s concordance correlation analysis indicated that the measurements showed weak concordance (< 0.90). Conclusion The formulas that estimate the insertion depth of the endotracheal tube in children were not accurate and were discordant with the gold-standard method of X-ray evaluation. There is a need for a new method based on anthropometric variables (weight and height) and age that is effective in guiding health professionals of pediatric intensive care units at the time of intubation.
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Childhood Idiopathic Pulmonary Arterial Hypertension Complicated by Esophageal Intubation: A Case Report. Am J Forensic Med Pathol 2018; 40:94-98. [PMID: 30161032 DOI: 10.1097/paf.0000000000000426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Childhood idiopathic pulmonary arterial hypertension (CIPAH) represents a rare disorder of childhood characterized by dyspnea, exercise limitation, and syncope. Common organ-specific pathology includes right ventricular myocardial hypertrophy. The case presented represents a classic case of CIPAH, where death was partially attributable to an unrecognized esophageal intubation, which was placed during emergency transport to an emergency department. The features of CIPAH are presented, along with a discussion related to esophageal intubation and death.
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13
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Claret PG, Bobbia X, de La Coussaye JE. Discrepancy Between Pediatric and Adult Patients Concerning Misplaced Endotracheal Tubes During Intubation. J Emerg Med 2017; 52:578. [PMID: 28126255 DOI: 10.1016/j.jemermed.2016.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 06/06/2023]
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