Abstract
Background
Correct positioning of the endotracheal tube (ETT) during emergent pediatric intubations
can be challenging, and incorrect placement may be associated with higher rates of
complications.
Objectives
The aims of this study are to: 1) assess the prevalence of clinically undetected misplaced
ETTs after intubation in the pediatric emergency department; 2) identify predictors
of ETT misplacement; and 3) evaluate for any association between intubation-related
complications and ETT position.
Methods
In this retrospective cross-sectional study, the primary outcome was rate of unrecognized
low or high ETTs detected on confirmatory chest radiographs. The secondary outcome
was frequency of complications (i.e., hypoxemia, difficult ventilation, atelectasis,
pneumothorax, pneumomediastinum, and aspiration) associated with misplaced ETTs. Multivariable
analyses were used to evaluate the associations between patient and procedural characteristics
and misplaced ETTs and between ETT position and complications.
Results
Seventy-seven of 201 (38.3%) intubations performed in the emergency department resulted
in clinically unrecognized misplaced ETTs. Of the misplaced tubes, 45 of 77 (58%)
were identified as low and 32 (42%) were high. In multivariable analyses, female sex
and decreasing age were associated with increased risk of low tube placement (odds
ratio for female sex, 2.4 [95% confidence interval, 1.1-5.1]; odds ratio of decreasing
age, 1.16 [95% confidence interval, 1.0-1.3]). Low tube misplacement was associated
with an increased risk of intubation-related complications compared to both correct
and high tube placement (p < 0.05, Chi-square).
Conclusion
Clinically unrecognized ETT misplacement occurs frequently in the pediatric emergency
department, with low placement being most common, particularly in girls and younger
children. Measures to improve clinical or radiographic recognition of incorrect tube
position should be considered.
Keywords
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Article info
Publication history
Published online: May 25, 2016
Accepted:
April 5,
2016
Received in revised form:
March 23,
2016
Received:
January 23,
2016
Footnotes
Reprints are not available from the authors.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
