Document Detail


Continuous monitoring of dynamic pulmonary compliance enables detection of endobronchial intubation in infants and children.
MedLine Citation:
PMID:  17578956     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Auscultation of breath sounds is used routinely to confirm tracheal placement of endotracheal tubes (ETT). In infants and children, this method is limited by the conduction of breath sounds bilaterally, despite endobronchial intubation. Although several methods of detecting endobronchial intubation have been described, none is both simple and reliable. In this investigation, we determined whether changes in pulmonary compliance and airway pressures, measured using continuous side stream spirometry, can reliably detect endobronchial intubation in pediatric patients. METHODS: Forty patients aged 1 month to 6 years were included. After endotracheal intubation the ETT was incrementally advanced as two observers monitored breath sounds and spirometry (Pressure-Volume Loops). Changes in pulmonary compliance, peak inspiratory pressure, or auscultation were reported, at which point ETT position was confirmed by fiberoptic bronchoscopy. RESULTS: Endobronchial intubation decreased measured pulmonary compliance by 45 +/- 11% (mean +/- sd; P < 0.001, Range 26%-66%) and increased peak airway pressures by 26 +/- 17% (mean +/- sd; P < 0.001, Range 0-87). Changes in peak airway pressures were smaller and more variable when compared to changes in compliance. Breath-sound auscultation failed to detect endobronchial intubation in 7.5% of cases. CONCLUSIONS: Pulmonary compliance changes are a sensitive and an accurate indicator of endobronchial intubation in infants and children. Both increased peak airway pressures and changes in breath sounds are less sensitive indicators of endobronchial intubation.
Authors:
Aman Mahajan; Nir Hoftman; Angela Hsu; Robert Schroeder; Samuel Wald
Related Documents :
16708956 - Numerical study of the effects of inferior and superior vocal fold surface angles on vo...
19554636 - Differentiating between adductor and abductor spasmodic dysphonia using airflow interru...
19075456 - High sound pressure levels in bavarian discotheques remain after introduction of volunt...
17388446 - Pressure-induced reduction of shielding for improving sonochemical activity.
8198416 - To peep or not to peep?
8488616 - Varicoceles: effect on testicular volume in prepubertal and pubertal males.
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Anesthesia and analgesia     Volume:  105     ISSN:  1526-7598     ISO Abbreviation:  Anesth. Analg.     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-20     Completed Date:  2007-07-19     Revised Date:  2007-12-03    
Medline Journal Info:
Nlm Unique ID:  1310650     Medline TA:  Anesth Analg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  51-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. amahajan@mednet.ucla.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Age Factors
Child
Child, Preschool
Female
Humans
Infant
Intubation, Intratracheal / instrumentation,  methods*
Lung Compliance / physiology*
Male
Monitoring, Intraoperative / instrumentation,  methods*
Respiratory Sounds / physiology
Grant Support
ID/Acronym/Agency:
P01 HL078931/HL/NHLBI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  The transesophageal Doppler and hemodynamic effects of epidural anesthesia in infants anesthetized w...
Next Document:  Remifentanil halves the EC50 of propofol for successful insertion of the laryngeal mask airway and l...