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Evaluation of Manual Cuff Palpation to Confirm Proper Endotracheal Tube Depth

Published online by Cambridge University Press:  17 February 2017

David Ledrick ,
Michael Plewa ,
Kevin Casey ,
Jay Taylor  and
Nancy Buderer
David Ledrick*
Affiliation:
Emergency Medicine Residency Program, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
Michael Plewa
Affiliation:
Emergency Medicine Residency Program, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
Kevin Casey
Affiliation:
Emergency Medicine Residency Program, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
Jay Taylor
Affiliation:
Emergency Medicine Resident, St. Vincent Mercy Medical Center, Toledo, Ohio, USA
Nancy Buderer
Affiliation:
Independent Consultant, Oak Harbor, Ohio, USA
*
David Ledrick, MD, 5862 Rock Hill Lane, Sylvania OH, 43560 USA, E-mail: ledrick@buckeye-express.com
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Abstract

Introduction: In the prehospital setting, optimal endotracheal tube (ETT) depth may be approximated using the patient's sex or height, and assessed by auscultation. Even when using these methods, the ETTs still may be placed at inappropriate depths.

Problem: This study assessed the inter-rater reliability and accuracy of manual cuff palpation (ballottement) at excluding an improperly placed ETT depth in adult patients.

Methods: This is a prospective, observational, pilot study in a convenience sample of adults recently intubated in the prehospital, medical floor, intensive care unit, or emergency department settings of an urban, teaching hospital. Two physician participants separately performed ballottement on each intubated subject and rated the ballottement as none, weak, or strong prior to assessment of appropriate depth using a chest radiograph (CXR). Results were compared for simple agreement and compared to the CXR to estimate accuracy.

Results: Of 163 patients, 27 (17%) had an inappropriate ETT depth. Physician assessments of ballottement agreed in 79% of patients (95% CI = 72-85%). Chest radiograph assessment found the ETT in the “strong” ballottement group properly placed in 93%, as compared to 77% in the “weak”, and 42% in the “none” groups. Combining “weak” and “strong” ballottement, the sensitivity was 96% (95% CI = 93–100%), specificity was 26% (95% CI = 9–43%), and accuracy was 85% (95% CI = 79–90%).

Conclusions: Manual cuff palpation is a simple and reproducible technique that is sensitive, but nonspecific, in identifying intubations of appropriate depth.

Keywords

airwayballottementchest x-rayendotracheal tubeintubationmanual cuff palpationprehospital settingreliability
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 23 , Issue 3 , June 2008 , pp. 270 - 274
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2008

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