Detection of airway CO2 partial pressure to avoid esophageal intubation

During endotracheal intubation, checking the position of endotracheal tube is important in order to avoid accidental esophageal intubation. Exhaled CO2 pressures of 50 emergent intubation attempts were recorded in our pediatric intensive unit to evaluate the efficacy of capnography in the early detection of esophageal intubation. Adjustment of the tube position was performed when indicated. In successful endotracheal intubation, the end-tidal CO2 pressures (PetCO2) ranged from 10 mmHg to 80 mmHg with typical respiratory phasic waveforms. In cases of inadvertent esophageal intubation, the PetCO2 values were less than 5 mmHg and revealed no typical respiratory pattern. It was also observed that PetCO2 decreased during one lung intubation or when the tip of endotracheal tube was pulled above the glottis. Capnographic monitoring end-tidal CO2 pressure continuously may be a reliable, time-saving tool for the detection of inadvertent esophageal intubation and the evaluation of proper positioning of the endotracheal tube.