Preventing unrecognised oesophageal intubation.

Area of Science:

• Medical Safety
• Anesthesiology
• Airway Management

Background:

• Unrecognised oesophageal intubation poses significant risks despite existing safety campaigns.
• Publicly reported incidents likely underestimate the true frequency of this critical error.

Purpose of the Study:

• To summarize the 2022 consensus guideline for preventing unrecognised oesophageal intubation.
• To provide actionable recommendations for all airway operators and assistants across clinical settings.

Main Methods:

• Emphasis on videolaryngoscopy, capnography, and oxygen saturation monitoring for all tracheal intubations.
• Introduction of the concept of sustained exhaled carbon dioxide as a key indicator.
• Guidelines for immediate tube removal if sustained exhaled carbon dioxide is absent, unless removal poses a clear danger.

Main Results:

• The guideline provides a framework for avoiding, recognizing, and managing potential oesophageal intubation.
• Sustained exhaled carbon dioxide is central to identifying oesophageal intubation.
• Default action in absence of sustained exhaled carbon dioxide is tube removal, prioritizing patient safety.

Conclusions:

• Adherence to the guideline, including videolaryngoscopy and capnography, is crucial for preventing harm.
• Human factors, such as clear communication and team collaboration, are vital for minimizing errors.
• The guideline promotes a proactive approach to airway management, prioritizing patient safety over the risk of removing a correctly placed tube.