Abstract
Purpose: We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI).
Clinical features: Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient’s lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60%vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally.
Conclusion: This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation.
Résumé
Objectif: Nous décrivons l’effet qu’une intubation oesophagienne involontaire a eu sur les images et sur la distribution des vibrations de l’imagerie par réponse vibratoire (VRI — vibration response imaging).
Éléments cliniques: L’imagerie par réponse vibratoire (VRI) est une nouvelle technologie informatique non invasive qui mesure l’énergie de vibration des sons pulmonaires pendant la respiration et affiche l’intensité régionale en format visuel et graphique. Les images de réponse vibratoire obtenues avant l’intubation trachéale (respiration spontanée) et pendant la ventilation endotrachéale à l’aide d’un mode contrôlé ont eu pour résultat des vibrations uniformément distribuées dans l’ensemble des poumons du patient. Cependant, pendant la ventilation oesophagienne involontaire, la majorité des vibrations ont été détectées dans la région supérieure de l’image, par rapport à celle de la région inférieure (60 % vs 8 %, respectivement). Durant la respiration spontanée et la respiration endotrachéale, la colonne de détecteurs médio-claviculaires situés au dessus du centre de chaque poumon a détecté davantage de vibrations que les colonnes de détecteurs médianes et axillaires. Pendant une ventilation oesophagienne involontaire, davantage de vibrations ont été détectées par la colonne médiane de détecteurs (la plus proche de la ligne médiane / œsophage) ; moins de vibrations ont été détectées par ceux situés davantage sur les côtés.
Conclusion: Ce compte-rendu démontre le potentiel qu’une image visuelle de la distribution de l’énergie de vibration pulmonaire pourrait avoir pour distinguer l’intubation endotrachéale d’une intubation oesophagienne involontaire.
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References
Stone DJ, Gal TJ. Airway management.In: Miller RD (Ed.). Anaesthesia, 5th ed. New York: Churchill Livingstone Inc.; 2000: 1414–51.
O’Connor CJ, Mansy H, Balk RA, Tuman KJ, Sandler RH. Identification of endotracheal tube malpositions using computerized analysis of breath sounds via electronic stethoscopes. Anesth Analg 2005; 101: 735–9.
Alliaume B, Coddens J, Deloof T. Reliability of auscultation in positioning of double-lumen endobronchial tubes. Can J Anaesth 1992; 39: 687–90.
Andersen KH, Schultz-Lebahn T. Oesophageal intubation can be undetected by auscultation of the chest. Acta Anaesthesiol Scand 1994; 38: 580–2.
Knapp S, Kofler J, Stoiser B, et al. The assessment of four different methods to verify tracheal tube placement in the critical care setting. Anesth Analg 1999; 88: 766–70.
Verghese ST, Hannallah RS, Slack MC, Cross RR, Patel KM. Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children. Anesth Analg 2004; 99: 56–8.
Raphael DT, Crookes P, Arnaudov D, Benbassat M. Acoustic reflectometry esophageal profiles minimally affected by massive gas ventilation. Am J Emerg Med 2005; 23: 747–53.
Sugiyama K, Yokoyama K, Satoh K, Nishihara M, Yoshitomi T. Does the Murphy eye reduce the reliability of chest auscultation in detecting endobronchial intubation? Anesth Analg 1999; 88: 1380–3.
Menegazzi JJ, Heller MB. Endotracheal tube confirmation with colorimetric CO2 detectors. Anesth Analg 1990; 71: 441–2.
Dellinger RP, Jean S, Cinel I, et al. Regional distribution of acoustic-based lung vibration as a function of mechanical ventilation mode. Crit Care 2007; 11: R26.
Dellinger RP, Parrillo JE, Kushnir A, Rossi M, Kushnir I. Dynamic visualization of lung sounds with a vibration response device: a case series. Respiration 2007; doi: 10.1159/000103558.
Cinel I, Jean S, Gratz I, Deal E, Tay C, Littman J. Acoustic monitoring of one-lung ventilation with vibration response imaging. Crit Care 2007; 11(Suppl 2): P202.
Tejman-Yarden S, Lederman D, Eilig I, et al. Acoustic monitoring of double-lumen ventilated lungs for the detection of selective unilateral lung ventilation. Anesth Analg 2006; 1003: 1489–93.
Tomaske M, Gerber AC, Stocker S, Weiss M. Tracheobronchial foreign body aspiration in children — diagnostic value of symptoms and signs. Swiss Med Wkly 2006; 136: 533–8.
Mor R, Kushnir I, Meyer JJ, Ekstein J, ben-Dov I. Breath sound distribution images of patients with pneumonia and pleural effusion. Respir Care 2007; 52: 1753–60.
Bentur L, Livnat G, Husein D, Pollack S, Rotschild M. Dynamic visualization of breath sound distribution in suspected foreign body aspiration: a pediatric case series. Journal of Bronchology 2007; 14: 156–61.
Kramer MR, Raviv Y, Hardoff R, Shteinmatz A, Amital A, Shitrit D. Regional breath sound distribution analysis in single-lung transplant recipients. J Heart Lung Transplant 2007; 26: 1149–54.
Kramer MR. Dynamic visualization of breath sound distribution: can we see the voices? Journal of Bronchology 2007; 14: 142–3.
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Conflict of interest: RPD and JEP have consultant agreements with Deep Breeze Inc. that include honoraria and stock options (no current monetary value). Research personnel and materials for the VRI research program at Cooper University Hospital are partially funded by Deep Breeze Inc. IC, SJ, CT, IG and ED have no conflicts to disclose.
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Cinel, I., Jean, S., Tay, C. et al. Case report: Vibration response imaging findings following inadvertent esophageal intubation. Can J Anesth 55, 172–176 (2008). https://doi.org/10.1007/BF03016092
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DOI: https://doi.org/10.1007/BF03016092