Continuous monitoring of endotracheal tube positioning: closer to the sangreal?

Excerpt

Endotracheal intubation is carried out routinely in anaesthetic, critical care and emergency practice by clinicians and paramedics with different levels of experience in airway management. Safe positioning of the endotracheal tube (ETT) requires the tip of the ETT to lie 2.5–4 cm above the carina when the patient’s head is in the neutral position [1]. Bronchial intubation, which occurs when the ETT is inadvertently placed in a main-stem bronchus, is still a significant problem in intensive care medicine and ranges from 2 to 6 % of all intubation-related incidents, reaching a 10 % incidence in some studies when emergency and non-emergency intubations were considered [2, 3]. It can occur secondary to a change in the patient’s position, coughing, suctioning or secondary to flexion or extension of the head and is more likely to occur in women compared to men [4, 5]. Serious complications can occur, including hypoxemia caused by atelectasis of the unventilated lung, and pneumothorax of the intubated lung caused by hyperinflation and barotrauma [6]. …