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Breath sound changes associated with malpositioned endotracheal tubes.

H A Mansy1, C J O'Connor, R A Balk

  • 1Biomedical Acoustics Research Group, Department of Pediatrics, Rush Medical College, Chicago, IL, USA. hansen_mansy@rush.edu

Medical & Biological Engineering & Computing
|May 4, 2005
PubMed
Summary

Computerized analysis of breath sounds can help confirm correct endotracheal tube (ETT) placement. This method detects esophageal or mainstem bronchial intubation by analyzing acoustic energy ratios, improving patient safety.

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Area of Science:

  • Anesthesiology
  • Respiratory Medicine
  • Biomedical Engineering

Background:

  • Endotracheal tubes (ETTs) are critical for airway management in patients with ventilatory failure and during anesthesia.
  • Incorrect ETT positioning can lead to severe respiratory compromise, increased morbidity, and mortality.
  • Current clinical assessment of ETT position via chest auscultation is subjective and prone to errors.

Purpose of the Study:

  • To investigate changes in breath sounds associated with endotracheal tube malpositioning.
  • To evaluate the potential of computerized breath sound analysis for confirming ETT placement.

Main Methods:

  • Breath sounds were recorded from six human subjects over the chest and epigastrium during tracheal, bronchial, and esophageal intubations.
  • Acoustic energy ratios between different body sites (epigastrium vs. chest, left vs. right hemithorax) were analyzed.

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  • Bandpass filtering (200-500 Hz) was applied to assess its impact on ratio analysis.

    • Main Results:

    • Esophageal intubation significantly increased the acoustic energy ratio between the epigastrium and chest surface (p < 0.04).
    • Right mainstem bronchial intubation decreased the acoustic energy ratio between the left and right hemithoraxes (p < 0.04).
    • Bandpass filtering at 200-500 Hz allowed for bronchial intubation identification without requiring a baseline ratio.

    Conclusions:

    • Computerized analysis of breath sounds shows promise as an objective method for assessing endotracheal tube positioning.
    • This technique may offer a more reliable alternative to traditional auscultation for confirming ETT placement.
    • Further research is warranted to validate the clinical feasibility and utility of this approach.