Reliable Verification of Endotracheal Tube Location by Pilot Balloon Compression Technique of Tracheal Tube

Lee, Sang Kyi

Abstract

BACKGOUND: Correct placement of an endotacheal tube (ETT) is crucial, and an ideal test for confirmation of proper ETT placement should be simple and quick to perform, reliable, safe, inexpensive, and repeatable. Palpation of the ETT cuff at the suprasternal notch has been used by clinicians for many years, however the effectiveness of the technique has never been documented. So the author evaluated an efficacy of the pilot balloon compression technique to verify the correct location of an ETT.
METHODS
After anesthetic induction and confirmation of orotracheal intubation, the patient's head is placed in a neutral position. The ETT is withdrawn or advanced while gentle, repeated pressure is applied with the fingers at the pilot balloon. Simultaneously, the suprasternal notch is palpated in the other hand. When the cuff maximally distends from the pressure applied at the pilot balloon, the ETT is secured. After securing the ETT, the distances from its tip to the upper incisor and the carina were measured by means of fiberoptic laryngoscopy.
RESULTS
Endobroncheal intubation was noted in three patients (3%). Average distance from the tip of the ETT to upper incisor in men was 23.9 cm (range, 21.7~26.9) and in women 22.5 cm (range, 20.0~26.0). Average distance to the carina in men was 2.6 cm (range, -0.5~5.0) and in women 1.8 cm (range, -0.6~4.4).
CONCLUSIONS
In this study, location of the ETT was not reliably confirmed by the technique. So the technique should need some modification. When maximal sensation of the ETT cuff is palpated 2.4~3.3 cm in men and 3.2~3.7 cm in women above the suprastenal notch, the location of the ETT tip is theoretically reliable. However, the technique should not be used to verify endotracheal intubation itself.