J Clin Monit Comput - Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff.

Tópicos

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Resumo

Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15?mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27?mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3?min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup.

Resumo Limpo

earli detect accident endobronchi intub ebi still unsolv problem anesthesia critic care daili practic aim studi evalu abil monitor cuff co detect ebi work hypothesi origin co unventil still perfus lung six goat intub general anesthesia ett posit verifi flexibl bronchoscop anapnoguard system alreadi success use detect air leak around ett cuff use continu monitor abovethecuff co level ett distal tip locat trachea averag cuff pressur mmhg absenc co cuff observ ett deliber advanc one main bronchi flexibl bronchoscop vision six case immedi presenc co cuff identifi automat inflat cuff level mmhg affect abovethecuff measur co level withdraw ett reposit distal tip midtrachea caus disappear co cuff maximum min confirm absenc air leak correct posit ett result suggest measur abovethecuff co level offer reliabl onlin solut earli identif accident ebi studi plan valid efficaci method clinic setup

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