Abstract
Purpose: To ensure that the endotracheal tube (ETT) is ideally placed for proper ventilation, radiographic confirmation of ETT placement is frequently used to supplement clinical examination in the intensive care unit setting. However, fluoroscopy rarely serves the same role during surgery, despite the fact that portable units are often present in the operating room. The purpose of this study was to ascertain the value of fluoroscopy in determining ETT malposition among the pediatric surgical population.
Methods: Chest radiographs from 257 children (age 12 days- 12 yr), who presented for a total of 446 individual procedures in the fluoroscopy suite, were studied to determine the incidence of ETTs placed too shallow (above the inferior clavicular border) or too deep (at or below the carina). A logistic regression with outcomes of correct and incorrect was used to analyze the data points.
Results: Eighteen percent of all the radiographs showed initial improper ETT placement, despite clinical evidence suggesting the contrary. The peak incidence of malposition, which occurred in patients under one year old, reached 35%. Incidence decreased with advancing age, but remained over 10% until the age of ten. A second attempt at positioning the tube, based on information from the chest radiograph, was successful in 95% of the cases. The remaining 5% required placement of the ETT under continuous fluoroscopic guidance.
Conclusion: Fluoroscopy, when readily available in the operating room, is a safe and useful technique to ensure proper ETT placement among the pediatric population.
Résumé
Objectif: Lorsqu’on veut s’assurer que le tube endotrachéal est adéquatement placée pour une bonne ventilation, la confirmation radiographique du positionnement du tube est souvent utilisée pour complémenter l’examen clinique dans l’unité des soins intensifs. Cependant, il est rare que la fluoroscopie joue le même rôle pendant la chirurgie, malgré le fait que des unités portables soient souvent à disposition dans la salle d’opération. L’objectif de cette étude était de confirmer la valeur de la fluoroscopie pour détecter le mauvais positionnement du tube endotrachéal chez des patients de chirurgie pédiatriques.
Méthode: Les radiographies du thorax de 257 enfants (âgés de 12 jours à 12 ans) qui ont subi un total de 446 interventions individuelles dans la salle de fluoroscopie, ont été étudiées afin de déterminer l’incidence de tubes endotrachéaux positionnées au dessus de la ligne claviculaire (pas assez profond) ou à ou au dessous de la carène (trop profond). Une analyse par régression logistique avec le binôme correct / incorrect a été utilisée pour évaluer les points de données.
Résultats: Au total, 18 % des radiographie ont montré un positionnement initialement inadéquat du tube endotrachéal, malgré le fait que les données cliniques suggéraient le contraire. L’incidence maximale de mauvais positionnement, qui a été observée chez les patients de moins d’un an, a atteint 35 %. L’incidence diminuait avec l’âge, mais demeurait au dessus de 10 % jusqu’à dix ans. Une deuxième tentative de positionnement de la sonde sur la base des informations tirées de la radiographie du thorax, a été réussie dans 95 % des cas. Les 5 % restants ont nécessité un positionnement de la sonde endotrachéale sous monitorage fluoroscopique continu.
Conclusion: Lorsqu’elle est à portée de main dans la salle d’opération, la fluoroscopie est une technique sécuritaire et utile pour s’assurer du positionnement correct du tube endotrachéal dans une population pédiatrique.
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Source of fnancial support: Departments of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami / Miller School of Medicine, Miami, Florida, USA.
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Harris, E.A., Arheart, K.L. & Penning, D.H. Endotracheal tube malposition within the pediatric population: a common event despite clinical evidence of correct placement. Can J Anaesth 55, 685–690 (2008). https://doi.org/10.1007/BF03017744
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DOI: https://doi.org/10.1007/BF03017744