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Inflating the endotracheal tube cuff with saline to confirm correct depth using bedside ultrasonography

Published online by Cambridge University Press:  11 February 2015

Mark O. Tessaro ,
Alexander C. Arroyo ,
Lawrence E. Haines  and
Eitan Dickman
Mark O. Tessaro*
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
Alexander C. Arroyo
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
Lawrence E. Haines
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
Eitan Dickman
Affiliation:
Division of Emergency Ultrasound, Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
*
Correspondence to: Dr. Mark Tessaro, Department of Emergency Medicine, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219; MTessaro@maimonidesmed.org

Abstract

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Although bedside ultrasonography can accurately distinguish esophageal from tracheal intubation, it is not used to establish the correct depth of endotracheal tube insertion. As indirect sonographic markers of endotracheal tube insertion depth have proven unreliable, a method for visual verification of correct tube depth would be ideal. We describe the use of saline to inflate the endotracheal cuff to confirm correct endotracheal tube depth (at the level of the suprasternal notch) by bedside ultrasonography during resuscitation. This rapid technique holds promise during emergency intubation.

Résumé

Bien que l’é chographie au chevet des patients permette de distinguer nettement l’intubation oesophagienne de l’intubation endotrachéale, elle n’est toutefois pas utilisée pour déterminer si la sonde a été posée à la bonne profondeur dans la trachée. Comme on ne peut se fier aux marqueurs échographiques indirects de vérification de la profondeur de pénétration de la sonde endotrachéale, l’idéal serait de procéder par vérification visuelle. II sera question ici du gonflement du ballonnet endotrachéal avec une solution saline pour confirmer l’introduction de la sonde à la bonne profondeur (à la hauteur de la fourchette sternale) par échographie au chevet des patients durant les manoeuvres de réanimation. Cette technique rapide se révèle prometteuse dans le contexte des intubations d’urgence.

Keywords

bedside ultrasonographyendotracheal tubeintubation
Type
Case Report
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 94 - 98
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

References

1.Milling, TJ, Jones, M, Khan, T, et al. Transtracheal 2-D ultrasound for identification of esophageal intubation. JEmerg Med 2007;32:409–414, doi:10.1016/j.jemermed.2006.08.022.Google Scholar
2.Werner, SL, Smith, CE, Goldstein, JR, et al. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med 2007;49:75–80, doi:10.1016/j.annemergmed.2006.07.004.Google Scholar
3.Muslu, B, Sert, H, Kaya, A, et al. Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients. J Ultrasound Med 2011;30:671–676.Google Scholar
4.Chou, HC, Tseng, WP, Wang, CH, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation 2011;82:1279–1284, doi:10.1016/j.resuscitation.2011.05.016.Google Scholar
5.Saglam, C, Unluer, EE, Karagtiz, A. Confirmation of endotracheal tube position during resuscitation by bedside ultrasonography. Am J Emerg Med 2013;31:248–250, doi:10. 1016/j.ajem.2012.08.002.Google Scholar
6.Galicinao, J, Bush, AJ, Godambe, SA. Use of bedside ultrasonography for endotracheal tube placement in pedia-tric patients: a feasibility study. Pediatrics 2007;120:1297–1303, doi:10.1542/peds.2006-2959.Google Scholar
7.Marciniak, B, Fayoux, P, Hebrard, A, et al. Airway management in children: ultrasonography assessment of tracheal intubation in real time? Anesth Analg 2009;108:461–465, doi:10.1213/ane.0b013e31819240f5.Google Scholar
8.Mora-Matilla, M, Alonso-Quintela, P, Oulego-Erroz, I, et al. Is ultrasound a feasible tool to verify endotracheal tube position in neonates?. Resuscitation 2013;84:e19–20, doi:10. 1016/j.resuscitation.2012.09.026.Google Scholar
9.Dennington, D, Vali, P, Finer, NN, et al. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology 2012;102:185–189, doi:10.1159/000338585.CrossRefGoogle ScholarPubMed
10.Slovis, TL, Poland, RL. Endotracheal tubes in neonates: sonographic positioning. Radiology 1986;160:262–263.Google Scholar
11.Lingle, PA. Sonographic verification of endotracheal tube position in neonates: a modified technique. JClinUltrasound 1988;16:605–609, doi:10.1002/jcu.1870160816.Google Scholar
12.Sim, SS, Lien, WC, Chou, HC, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation. Resuscitation 2012;83:307–312, doi:10.1016/j.resuscitation.2011.11.010.CrossRefGoogle ScholarPubMed
13.Kerrey, BT, Geis, GL, Quinn, AM, et al. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics 2009;123:e1039–44, doi:10.1542/peds.2008-2828.Google Scholar
14.Youssefian, A, Turner, E, Breazeale, S, et al. Three-window bedside ultrasound versus chest radiography for confirmation of endotracheal tube placement. Poster session presented at American Institute of Ultrasound in Medicine Annual Conference; 2013 Apr 6-10; New York, NY.Google Scholar
15.Navarro, RM, Baughman, VL. Lidocaine in the endotracheal tube cuff reduces postoperative sore throat. JClinAnesth 1997;9:394–397, doi:10.1016/S0952-8180(97)00068-8.Google ScholarPubMed
16.Mitchell, V, Adams, T, Calder, I. Choice of cuff inflation medium during nitrous oxide anaesthesia. Anaesthesia 1999;54:32–36, doi:10.1046/j.1365-2044.1999.00646.x.Google Scholar
17.Porter, NE, Sidou, V, Husson, J. Postoperative sore throat: incidence and severity after the use oflidocaine, saline, or air to inflate the endotracheal tube cuff. AANA J 1999;67:49–52.Google Scholar
18.Bennett, MH, Isert, PR, Cumming, RG. Postoperative sore throat and hoarseness following tracheal intubation using air or saline to inflate the cuff—a randomized controlled trial. Anaesth Intensive Care 2000;28:408–413.CrossRefGoogle ScholarPubMed
19.Ahmad, NL, Norsidah, AM. Change in endotracheal tube cuff pressure during nitrous oxide anaesthesia: a comparison between air and distilled water cuff inflation. Anaesth Intensive Care 2001;29:510–514.Google Scholar
20.Combes, X, Schauvliege, F, Peyrouset, O, et al. Intracuff pressure and tracheal morbidity: influence of filling with saline during nitrous oxide anesthesia. Anesthesiology 2001;95:1120–1124, doi:10.1097/00000542-200111000-00015.Google Scholar
21.Malhotra, S, Singh, M, Malhotra, N. Tracheal morbidity following tracheal intubation: comparison of air, saline and lignocaine used for inflating cuff. J Anaesthesiol Clin Pharmacol 2007;23:163–167.Google Scholar
22.Shroff, PP, Patil, V. Efficacy of cuff inflation media to prevent postintubation-related emergence phenomenon: air, saline and alkalinized lignocaine. Eur J Anaesthesiol 2009;26:458–462, doi:10.1097/EJA.0b013e32832403fa.Google Scholar
23.Behzadi, M, Hajimohamadi, F, Alagha, AE, et al. Endotracheal tube cuff lidocaine is not superior to intravenous lidocaine in short pediatric surgeries. Int J Pediatr Otorhinolaryngol 2010;74:486–488, doi:10.1016/j.ijporl. 2010.01.025.Google Scholar
24.Dadure, C, Granier, M, Bringuier, S, et al. Comparison of saline, air, and a mixture oxygen-nitrous oxide for endo-tracheal cuff tracheal tube inflation in children? A prospective randomized trial. Ann Fr Anesth 2010;29:687–692, doi:10.1016/j.annfar.2010.06.022.Google Scholar
25.Matsuo, K, Akata, T, Yamaura, K, et al. [Intraoperative monitoring of pressure within saline-filled, endotracheal tube cuff in adult patients undergoing CO2 laser laryngo-microsurgery]. Masui 2002;51:482–488.Google Scholar
26.Agrawal, G, Agrawal, M, Dali, JS. Endotracheal tube cuff pressure with different media for cuff inflation and laryngo-tracheal morbidity. JAnaesthesiolClinPharmacol 2008;24:165.Google Scholar
27.Raphael, DT, Conard, FU. Ultrasound confirmation of endotracheal tube placement. J Clin Ultrasound 1987;15:459–462, doi:10.1002/jcu.1870150706.Google Scholar
28.Uya, A, Spear, D, Patel, K, et al. Can novice sonographers accurately locate an endotracheal tube with a saline-filled cuff in a cadaver model? A pilot study. Acad Emerg Med 2013;19:361–364, doi:10.1111/j.1553-2712.2012.01306.x.Google Scholar
29.Pattnaik, SK, Bodra, R. Ballotability of cuff to confirm the correct intratracheal position of the endotracheal tube in the intensive care unit. Eur J Anaesthesiol 2000;17:587–590, doi:10.1097/00003643-200009000-00008.Google Scholar
30.Pollard, RJ, Lobato, EB. Endotracheal tube location verified reliably by cuff palpation. Anesth Analg 1995;81:135–138.Google ScholarPubMed
31.Okuyama, M, Imai, M, Sugawara, K, et al. Finding appropriate tube position by the cuff palpation method in children. Masui 1995;44:845–848.Google Scholar
32.Goldman, JM, Armstrong, JP, Vaught, LE, et al. A new method for identifying the depth of insertion of tracheal tubes. Biomed Sci Instrum 1995;31:225–228.Google Scholar
33.Bissinger, U, Lenz, G, Kuhn, W. Unrecognized endobron-chial intubation of emergency patients. Ann Emerg Med 1989;18:853–855, doi:10.1016/S0196-0644(89)80211-2.Google Scholar
34.Geisser, W, Maybauer, DM, Wolff, H, et al. Radiological validation of tracheal tube insertion depth in out-of-hospital and in-hospital emergency patients. Anaesthesia 2009;64:973–977, doi:10.1111/j.1365-2044.2009.06007.x.Google Scholar
35.Sitzwohl, C, Langheinrich, A, Schober, A, et al. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial. BMJ 2010;341:c5943doi:10.1136/bmj.c5943.Google Scholar
36.Harris, EA, Arheart, KL, Penning, DH. Endotracheal tube malposition within the pediatric population: a common event despite clinical evidence of correct placement. Can J Anaesth 2008;55:685–690, doi:10.1007/BF03017744.Google Scholar
37.Klepper, ID, Webb, RK, Van der Walt, JH, et al. The Australian Incident Monitoring Study. The stethoscope: applications and limitations—an analysis of 2000 incident reports. Anaesth Intensive Care 1993;21:575–578.Google Scholar
38.Li, J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001;20:223–229, doi:10.1016/S0736-4679(00)00 318-8.CrossRefGoogle ScholarPubMed
39.Leong, MT, Ghebrial, J, Sturmann, K. The effect of vinegar on colorimetric end-tidal carbon dioxide determination after esophageal intubation. J Emerg Med 2005;28:5–11, doi:10. 1016/j.jemermed.2004.06.012.Google Scholar
40.Rudraraju, P, Eisen, LA. Analytic review: confirmation of endotracheal tube position: a narrative review. JIntensive Care Med 2009;24:283–292, doi:10.1177/0885066609340501.Google Scholar
41.Conrardy, PA, Goodman, LR, Lainge, F, et al. Alteration of endotracheal tube position. Flexion and extension of the neck. Crit Care Med 1976;4:7–12, doi:10.1097/00003246-197601000-00002.Google Scholar
42.Goodman, LR, Conrardy, PA, Laing, F, et al. Radiographic evaluation of endotracheal tube position. AJR Am J Roentgenol 1976;127:433–434, doi:10.2214/ajr.127.3.433.Google Scholar
43.Yap, SJ, Morris, RW, Pybus, DA. Alterations in endotracheal tube position during general anaesthesia. Anaesth Intensive Care 1994;22:586–588.Google Scholar