| Continuous monitoring of dynamic pulmonary compliance enables detection of endobronchial intubation in infants and children. | |
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MedLine Citation:
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PMID: 17578956 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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Aman Mahajan; Nir Hoftman; Angela Hsu; Robert Schroeder; Samuel Wald |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Anesthesia and analgesia Volume: 105 ISSN: 1526-7598 ISO Abbreviation: Anesth. Analg. Publication Date: 2007 Jul |
Date Detail:
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Created Date: 2007-06-20 Completed Date: 2007-07-19 Revised Date: 2007-12-03 |
Medline Journal Info:
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Nlm Unique ID: 1310650 Medline TA: Anesth Analg Country: United States |
Other Details:
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Languages: eng Pagination: 51-6 Citation Subset: AIM; IM |
Affiliation:
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Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA. amahajan@mednet.ucla.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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P01 HL078931/HL/NHLBI NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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