New Imaging Protocol to Assess Endotracheal Tube Placement: A Case-control Study.

Area of Science:

• Radiology
• Medical Imaging
• Critical Care Medicine

Background:

• Endotracheal tube (ETT) position on chest X-ray (CXR) is crucial for patient safety.
• ETT tip location can change with patient neck position, complicating assessment.
• Standard CXRs often do not visualize the mandible, hindering accurate ETT position evaluation.

Purpose of the Study:

• To develop and evaluate a new CXR protocol to improve endotracheal tube (ETT) position assessment.
• To determine if visualizing the mandible on postintubation CXR enhances ETT position accuracy.
• To compare the rate of confident ETT position assessment between standard and new CXR protocols.

Main Methods:

• A prospective study comparing standard CXR with a new protocol requiring mandible visualization.
• Two groups of intubated patients were analyzed (n=308).
• Observers assessed neck position and ETT confidence based on mandible visibility and defined 'gray' and 'clear' zones.

Main Results:

• The new protocol significantly increased mandible visualization (92% vs 21%).
• Confident assessment of ETT position improved dramatically with the new protocol (96.7% vs 51.6%).
• High interrater agreement was observed for ETT-carina distance and mandible height measurements.

Conclusions:

• Mandible visibility on postintubation CXR is a valuable tool for assessing endotracheal tube (ETT) position.
• The new protocol significantly improves both mandible visualization and the accuracy of ETT position determination.
• This method offers a more reliable assessment of ETT placement in intubated patients.