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The use of impedance respirometry to confirm tracheal intubation in children
M Absolom1, R Roberts, U B Bahlmann
1University of Wales College of Medicine, Cardiff, Wales, UK.
Insights
Impedance respirometry accurately identified tracheal tube placement in children, aiding in preventing oesophageal intubation complications. This method, when combined with others, can reduce the time to detect incorrect tube placement.
Area of Science:
- Pediatric Anesthesiology
- Medical Device Technology
Background:
- Accidental oesophageal intubation in children poses significant risks, leading to morbidity and mortality.
- Accurate confirmation of tracheal tube placement is critical during pediatric anesthesia.
Purpose of the Study:
- To evaluate the effectiveness of impedance respirometry in confirming tracheal tube position in children aged 1-10 years.
- To assess the sensitivity and specificity of impedance respirometry for differentiating tracheal from oesophageal intubation.
Main Methods:
- Eighty children (aged 1-10 years) undergoing anesthesia had two tubes inserted: one tracheal, one oesophageal.
- A breathing system was connected to a randomly selected tube.
- A blinded observer used impedance respirometry to determine tube position within six breaths.
Main Results:
- Impedance respirometry correctly identified the position of 76 out of 80 tubes (95% accuracy).
- Sensitivity was 0.975 and specificity was 0.925.
- The median time to identify tube position was 2 breaths.
Conclusions:
- Impedance respirometry is a valuable tool for confirming tracheal tube placement in children.
- While not perfect, it can enhance diagnostic accuracy and potentially reduce delays in identifying incorrect intubations.
- Integration with other verification methods may further improve patient safety.
Abstract:
Accidental oesophageal intubation can occur in children and is a cause of morbidity and mortality. This study investigated the use of impedance respirometry to determine tracheal tube position in children aged 1-10 years. Eighty children were recruited and, after induction of anaesthesia, two identical tracheal tubes were inserted: one into the trachea and one into the oesophagus. The breathing system was attached to one of the tubes chosen at random. A blinded observer was asked to identify the position of the tube within six breaths using impedance respirometry. The positions of 76 out of 80 tubes were correctly identified. Of those incorrectly identified, one was in the trachea and three were in the oesophagus. The sensitivity of the test was 0.975 and the specificity 0.925. The median number of breaths needed to identify the position of the tubes was 2.0 for both groups. This is not a perfect technique in the population studied but when used with other methods of tracheal tube position identification, its use could decrease the time taken to identify incorrect placement.
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