Air Medical Journal
Volume 25, Issue 2 , Pages 74-80, March 2006

Verification of endotracheal tube placement by prehospital providers: Is a portable fiberoptic bronchoscope of value?

  • Timothy Angelotti, MD, PhD

      Affiliations

    • Department of Anesthesia, Stanford University Medical Center, Stanford, California
    • Stanford Life Flight Program, Stanford University Medical Center, Stanford, California
    • Corresponding Author InformationAddress for correspondence: Timothy Angelotti, Stanford University, Department of Anesthesia, 300 Pasteur Drive H3580, Stanford, CA 94305
    • ,
  • Eric L. Weiss, MD

      Affiliations

    • Stanford Life Flight Program, Stanford University Medical Center, Stanford, California
    • Department of Emergency Medicine, Stanford University Medical Center, Stanford, California
    • ,
  • Hendrikus J.M. Lemmens, MD, PhD

      Affiliations

    • Department of Anesthesia, Stanford University Medical Center, Stanford, California
    • ,
  • John Brock-Utne, MD, PhD

      Affiliations

    • Department of Anesthesia, Stanford University Medical Center, Stanford, California

Introduction

This study was designed to examine whether a handheld, battery-operated fiberoptic bronchoscope (FOB) used to verify endotracheal tube (ETT) placement would be as sensitive and specific as other modes and whether a combination of multiple modes would further enhance the sensitivity and specificity of ETT placement verification.

Setting

An academic hospital-based air medical program.

Methods

This was a prospective, randomized study examining surgical patients undergoing general endotracheal anesthesia. Eighteen critical care transport (CCT) nurses, previously unfamiliar with FOB, were asked to identify intratracheal and intraesophageal ETTs by using misting, end-tidal carbon dioxide concentration (ETCO2), and FOB alone or with a combination of all three modes. The sensitivity and specificity of single and multimode verification were calculated and compared.

Results

Comparison of ETT verification by single mode alone revealed a rank order of sensitivity with ETCO2 (0.97) > FOB (0.87) > misting (0.84), whereas all three modes had similar specificities (0.93-0.94). However, the use of the three-mode combination revealed a sensitivity and specificity of 1.0.

Conclusions

As a single mode for ETT verification, use of a handheld, battery-operated FOB device allowed for direct visualization and had an 87% sensitivity and 93% specificity. When combined with misting and ETCO2, FOB allowed 100% successful verification of ETT placement.

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 Presented at the Air Medical Transport Conference 2005, Austin, Texas, October 25, 2005. Supported in part by a grant from Stanford University Department of Anesthesia.Conflict of Interest StatementNone of the authors have any financial or personal relationship with Clarus Medical or other organizations that could inappropriately influence this work.

PII: S1067-991X(05)00221-X

doi:10.1016/j.amj.2005.12.001

Air Medical Journal
Volume 25, Issue 2 , Pages 74-80, March 2006

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