Which is the Best Bedside Test to Detect Endobronchial Intubation?
Condition: Endobronchial Intubation
Study type: Interventional

Summary: 
      Background: Endotracheal intubation has become a well established standard in protecting the
      airway during surgical procedures, and in emergency situations. Serious complications can
      occur from the incorrect placement of an endotracheal tube in a mainstem bronchus. If
      unrecognized it can lead to hypoxemia secondary to atelectasis of the unventilated lung and
      hyperinflation of the intubated lung, which can result in barotrauma. As bedside method the
      golden standard to verify the correct endotracheal tube placement is bilateral ausculation of
      the chest. However this is not always satisfactory, as breath sounds can be transmitted to
      the opposite side of the chest in spite of endobronchial intubation. Therefore other clinical
      tests to verify the correct endotracheal tube placement have become part of daily clinical
      practice, like observation of symmetric chest movements, and use of the cm markings printed
      on the endotracheal tube. However so far no study investigated which of these bedside
      clinical methods works best in detecting an inadvertently placed endobronchial tube in
      adults. We therefore designed a study to compare three different bedside methods to verify
      endotracheal or endobronchial tube placement.

      Objective: To determine which of four commonly used bedside methods of detecting inadvertent
      endobronchial intubation in adults has the highest sensitivity and specificity.

      Design: Prospective randomized, blinded study. Setting: Tertiary, academic hospital,
      department of anaesthesia. Participants: 160 consecutive ASA I or II patients, aged 19-75
      years, scheduled for elective gynaecological or urological surgery.

      Interventions: Patients were randomly assigned to eight study groups. In four groups, an
      endotracheal tube (ETT) was fiberoptically positioned 2.5-4.0 cm above the carina, whereas in
      the other four groups the tube was positioned in the right mainstem bronchus. The four groups
      differed in the bedside test used to verify the position of the endotracheal tube. First-year
      residents and experienced anaesthesiologists independently performed one of the following
      randomly assigned bedside tests in each patient in an effort to determine whether the tube
      was properly positioned in the trachea: 1) bilateral auscultation of the chest
      (Auscultation); 2) observation and palpation of symmetric chest movements (Observation); 3)
      estimating the position of the ETT by the insertion depth (Tube Depth); and, 4) a combination
      of all three mentioned tests (All Three).

      Main outcome measures: Correct and incorrect judgements of endotracheal tube (ETT) position
      as independently assessed by first-year anaesthesia residents and experienced
      anaesthesiologists with each of the four bedside tests.
    


Intervention name(s): Auscultation; Observation of symmetric chest movements; Tube depth; All three
Intervention type(s): Other; Other; Other; Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Diagnostic