Conflict of interest: None.
Original Article: Neonatal Lung Disease
A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model†
Version of Record online: 21 MAY 2012
Copyright © 2012 Wiley Periodicals, Inc.
Volume 48, Issue 2, pages 138–145, February 2013
How to Cite
Schmölzer, G. M., Bhatia, R., Davis, P. G. and Tingay, D. G. (2013), A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model. Pediatr. Pulmonol., 48: 138–145. doi: 10.1002/ppul.22580
- Issue online: 15 JAN 2013
- Version of Record online: 21 MAY 2012
- Manuscript Accepted: 6 MAR 2012
- Manuscript Received: 3 JAN 2012
- Neonatal Research Group of the Murdoch Childrens Research Institute
- Royal Women's Hospital Postgraduate Research Degree Scholarship and Monash International Postgraduate Research Scholarship
- Australian National Health and Medical Research Council Practitioner Fellowship
- National Health and Medical Research Council Clinical Research Fellowship. Grant Number: 491286
- Victorian Government Operational Infrastructure Support Program
- electrical impedance tomography;
- mechanical ventilation;
- respiratory function monitor;
- colorimetric carbon dioxide detector;
- respiratory inductive plethysmography
Endotracheal tube (ETT) malposition is common and an increasing number of non-invasive techniques to aid rapid identification of tube position are available. Electrical impedance tomography (EIT) is advocated as a tool to monitor ventilation.
This study aimed to compare EIT with five other non-invasive techniques for identifying ETT position in a piglet model.
Six saline lavage surfactant-depleted piglets were studied. Periods of ventilation with ETT placed in the oesophagus or a main bronchus (MB) were compared with an appropriately placed mid-tracheal ETT. Colorimetric end-tidal CO2 (Pedi-Cap®), SpO2 and heart rate, tidal volume () using a hot-wire anemometer at the airway opening, tidal volume using respiratory inductive plethysmography () and regional tidal ventilation within each hemithorax (EIT) were measured.
Oesophageal ventilation: Pedi-Cap® demonstrated absence of color change. , , and EIT correctly demonstrated no tidal ventilation. SpO2 decreased from mean (SD) 96 (2)% to 74 (12)% (P < 0.05; Bonferroni post-test), without heart rate change. MB ventilation: SpO2, heart rate and Pedi-Cap® were unchanged compared with mid-tracheal position. and decreased from a mean (SD) 10.8 (5.6) ml/kg and 14.6 (6.2) ml/kg to 5.5 (1.9) ml/kg and 6.4 (2.6) ml/kg (both P < 0.05; Bonferroni post-test). EIT identified the side of MB ventilation, with a mean (SD) 95 (3)% reduction in tidal volume in the unventilated lung.
EIT not only correctly identified oesophageal ventilation but also localized the side of MB ventilation. At present, no one technique is without limitations and clinicians should utilize a combination in addition to clinical judgement. Pediatr Pulmonol. 2013; 48:138–145. © 2012 Wiley Periodicals, Inc.