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Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in
F H Levy1, S L Bratton, D S Jardine
1University of Washington, Seattle.
Insights
Repositioning endotracheal tubes (ETTs) in pediatric intensive care units (PICUs) often fails, with 25% remaining malpositioned. Confirming correct ETT placement with chest radiographs (CXRs) after adjustments is crucial for patient safety.
Area of Science:
- Pediatric critical care medicine
- Medical imaging in pediatrics
- Airway management
Background:
- Endotracheal tube (ETT) malposition is a common complication in pediatric patients requiring mechanical ventilation.
- Accurate ETT placement is critical for effective ventilation and to prevent complications.
- Chest radiographs (CXRs) are frequently used to assess ETT position, but repositioning attempts may not always be successful.
Purpose of the Study:
- To determine the frequency of persistent endotracheal tube malposition in pediatric patients after repositioning attempts.
- To compare the incidence of malposition after repositioning versus initial correct placement.
Main Methods:
- Retrospective review of medical records and CXRs for pediatric patients in a PICU over a 4-month period.
- Identification of children with initially malpositioned ETTs and those with correctly positioned ETTs.
- Analysis of subsequent CXRs to assess ETT position after repositioning or routine intervals.
Main Results:
- Twenty-five percent (10 of 40) of pediatric patients had continued ETT malposition on the subsequent CXR after repositioning.
- Only 2% (1 of 47) of ETTs initially placed correctly became malpositioned by the next routine CXR (24 hours later).
- The difference in malposition rates between the repositioned and initially correct groups was statistically significant (p < 0.0001).
Conclusions:
- Repositioning of endotracheal tubes in pediatric patients frequently results in continued malposition.
- Radiographic confirmation of correct ETT position after repositioning is essential.
- Routine CXRs after ETT repositioning can improve patient outcomes by ensuring accurate airway management.
Abstract:
Attempts to correctly reposition endotracheal tubes (ETTs) are not always successful in pediatric patients, even when chest radiographs (CXRs) are measured to determine the distance that the ETT deviates from the correct position. We determined the frequency of continued ETT malposition after repositioning in a pediatric intensive care unit (PICU). Forty children with malpositioned ETTs were identified during a 4-month period. After repositioning, ten (25 percent) continued to be malpositioned on the next CXR. Of 47 children with correctly positioned ETTs, only one ETT (2 percent) was found to be incorrectly positioned on the next routine CXR obtained 24 h later. The difference in frequency of ETT malposition between these two groups of children is significant (p < 0.0001). The children were similar in weight and age. Despite repositioning based on measurements taken from a CXR, a large percentage of pediatric patients had continued ETT malposition. However, after radiographic documentation of correct position, we demonstrated that significant movement was uncommon. Routine confirmation of ETT position by CXRs should be considered after repositioning ETTs in pediatric patients.