Document Detail


A randomized controlled trial of capnography in the correction of simulated endotracheal tube dislodgement.
MedLine Citation:
PMID:  21676056     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Unrecognized dislodgement of an endotracheal tube (ETT) during the transport of an intubated patient can have life-threatening consequences. Standard methods to monitor these patients, such as pulse oximetry and physical examination, are both subject to inaccuracies with patient movement and ambient noise. Capnography provides a continuous and objective measure of ventilation that can alert a provider immediately to an airway problem. The objective of this study was to determine through simulation if capnography decreases time to correction of dislodged ETTs during the transport of intubated patients, in comparison to standard monitoring.
METHODS: Paramedics and paramedic students were randomized as to whether or not they had capnography available to them in addition to standard monitoring during a simulated scenario. In the scenario, subjects monitored an intubated baby who subsequently experiences a dislodgement of the ETT during interfacility transport. Time to correction of the ETT dislodgement was the primary outcome. The secondary outcome was correction of dislodgement prior to decline in pulse oximetry.
RESULTS: Fifty-three subjects were enrolled in the study, with complete data on 50 subjects. Median time to correction of ETT dislodgement was 2.02 minutes (95% confidence interval [CI] = 1.22 to 4.12 minutes) for the capnography group versus 4.00 minutes (95% CI = 3.35 to 5.50 minutes) in the standard monitoring group (p = 0.05). Forty-eight percent of subjects using capnography corrected the ETT dislodgement prior to decline in pulse oximetry compared with 12% of controls (p = 0.01). There were no differences in time to correction of dislodgement based on years of experience, perceived comfort, reported adequacy of teaching, or past use of capnography.
CONCLUSIONS: The addition of capnography to standard monitoring significantly improves recognition of ETT dislodgement and reduces the time to correction of dislodged ETTs by prehospital providers in a simulated pediatric transport setting.
Authors:
Melissa L Langhan; Kevin Ching; Veronika Northrup; Michelle Alletag; Payal Kadia; Karen Santucci; Lei Chen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Academic emergency medicine : official journal of the Society for Academic Emergency Medicine     Volume:  18     ISSN:  1553-2712     ISO Abbreviation:  Acad Emerg Med     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-16     Completed Date:  2011-12-13     Revised Date:  2013-06-28    
Medline Journal Info:
Nlm Unique ID:  9418450     Medline TA:  Acad Emerg Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  590-6     Citation Subset:  IM    
Copyright Information:
© 2011 by the Society for Academic Emergency Medicine.
Affiliation:
Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Melissa.langhan@yale.edu
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MeSH Terms
Descriptor/Qualifier:
Capnography*
Computer Simulation
Emergency Medical Services*
Equipment Failure
Humans
Infant
Intubation, Intratracheal*
Oximetry
Transportation of Patients
Grant Support
ID/Acronym/Agency:
UL1 RR024139/RR/NCRR NIH HHS; UL1 RR024139-06/RR/NCRR NIH HHS
Comments/Corrections

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


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