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Comparison of clinical methods to diagnose pediatric endobronchial intubation-A randomized controlled trial
Sathishkumar Selvaraj1, Lenin Babu Elakkumanan2, Hemavathy Balachandar2
1Department of Anesthesiology and Critical Care, Kauvery Hospital, Salem, Tamil Nadu, India.
Insights
Accurate endotracheal tube placement is vital in pediatrics. Combining all clinical tests offers the highest sensitivity (97%) for detecting endobronchial intubation, outperforming individual methods like tube depth.
Area of Science:
- Pediatric Anesthesiology
- Critical Care Medicine
- Medical Device Placement
Background:
- Accurate endotracheal tube (ETT) placement is critical for pediatric patient safety during anesthesia.
- Misplacement can lead to severe complications, necessitating reliable diagnostic methods.
Purpose of the Study:
- To evaluate the efficacy of five clinical methods for confirming endotracheal tube position in pediatric patients.
- To compare the diagnostic accuracy of individual tests versus a combination of tests.
Main Methods:
- A randomized crossover study involving 50 pediatric patients.
- Evaluation of five clinical methods: auscultation, chest movement observation, bag compliance, tube depth, and capnography.
- Comparison of test performance in detecting tracheal versus endobronchial intubation.
Main Results:
- Tube depth (88%) and the combination of all tests (97%) showed higher sensitivity for detecting endobronchial intubation compared to auscultation (70%) and observation (55%).
- The combination of all clinical tests provided the highest diagnostic accuracy.
Conclusions:
- Tube depth is a more effective individual clinical test than auscultation or observation for diagnosing endobronchial intubation in pediatric patients.
- Performing all evaluated clinical tests together significantly enhances the accuracy of endotracheal tube placement diagnosis.
Background And Aims:
Diagnosing accurate placement of the tip of the endotracheal tube is crucial in pediatric practice. This study was conducted to find out the efficacy of five clinical methods to ascertain the tube position by a resident anesthesiologist.
Material And Methods:
This was a randomized crossover study conducted in a research institute. Fifty pediatric patients were enrolled. All patients were randomly allocated to tracheal (group T) or bronchial group (group B). The five clinical methods which were evaluated include the auscultation, observation of chest movements, bag compliance, tube depth, and capnography. In group T, the tube was placed in the trachea and later positioned in bronchus (assisted by fiberoptic bronchoscopy). The vice versa was done in group B. In each position, a single test followed by all tests was performed and after the change of position, the same single test followed by all tests was performed. Correct and incorrect diagnoses by tests in detecting tube positions were made and their sensitivity and odds ratio were estimated.
Results:
The tube depth and combination of all tests detected endobronchial intubation with a sensitivity of 88% and 97%, respectively, which is more than that of auscultation (70%) and observation (55%). Evaluation of the difference in agreement level of tube depth to detect tube-position showed the odds ratio of 2.28 (0.17-30.95) for detecting endobronchial intubation.
Conclusion:
We observed that the tube-depth was better than the other individual tests in diagnosing endobronchial intubation in pediatric patients. However, its efficacy is lesser than that of performing all clinical tests together.
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