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Detection of Endotracheal Intubation by Insertion Depth of Endotracheal Tube, Bilateral Chest Auscultation, and Observation of Bilateral Chest Movement during Emergency Intubation: Prospective Observational Study

Indraneel Dasgupta Clinical Director and Head, Department of Emergency Medicine, Peerless Hospital & B.K.Roy Research Center, 360 Panchasayar, Kolkata - 700094, West Bengal , Indraneel Dasgupta , Sayani Banerjee , Sujoy Das Thakur

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Indian Journal of Emergency Medicine 3(1):p 112-120, January - June 2017. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3117.18

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Abstract

Introduction: Endotracheal intubation, a routine lifesaving procedure in Emergency Medicine practice, can cause serious life threat to the intubated patient if the position of the tube is not confirmed appropriately.We did a prospective observational study on 289 patients to determine whether a bedside method of correct placement of the endotracheal tube can be obtained. Methodology: The operators recorded their findings of insertion depth of endotracheal tube, chest auscultation, observation of symmetrical chest movement and finally their impression regarding position of endotracheal tube in a sequentially numbered form.The principal investigator compared the findings of the operator, with the post intubation chest radiograph,which was taken as the gold standard. Results: We found a very high sensitivity of 99%, 100% and 100% for chest auscultation,chest movement and combination of all three methods (chest auscultation, chest movement and depth of the E.T. tube). However, the specificity was low at 49% for chest auscultation, 40% in chest movement and 51 % for combination of three methods.We calculated that,in subjects of Indian ethnicity, the safe depth of  E.T. tube was 22cm in male and 21cm in females (p<0.001) to reduce the chances of endobronchial intubation. Conclusion : We conclude that a single test is not confirmatory to ascertain tube position and it is better to combine all findings together to give a better sensitivity and specificity. A 21/22 cm (female vs. male) insertion depth of endotracheal tube is suitable for Indian ethnic groups.
 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3117.18

Keywords

Endotracheal Intubation; Depth of ET Tube; Placement of Tube; Tracheal Tube.

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