Use of the Stethoscope to Confirm Breathing Tube Placement

Differentiation Between Esophageal and Tracheal Intubation Utilizing Neck Auscultation

This study is intended to validate the use of neck auscultation with an electronic stethoscope during intubation to confirm tracheal tube placement.

It is hypothesized that the ability to confirm correct tube placement with this technique will be similar to that of the end-tidal CO2 monitor, the current gold-standard device for confirming tracheal intubation.

Study Overview

• Status: Completed
• Conditions: Intubation, Endotracheal
• Intervention / Treatment: Procedure: Neck Auscultation

Detailed Description

Unrecognized esophageal intubation results in disastrous consequences. Fortunately, a variety of techniques have been cited to confirm placement of the endotracheal tube. However, even end-tidal CO2 monitoring, considered to be the gold standard, has been associated with false positive and false negative results. In addition, use of this monitor requires ventilation through the tube, resulting in gastric distention if the esophagus has been intubated.

When the lateral neck is auscultated during insertion of an endotracheal tube, there is a distinct difference between the sounds generated by a tube placed in the esophagus compared to a tube inserted into the trachea. Stethoscopes are readily available in any OR setting, and ventilation and release of cricoid pressure need not occur prior to confirmation of tube placement. However, this technique has yet to be validated.

A series of sounds heard at the lateral neck during both tracheal and esophageal intubation will be recorded using an electronic stethoscope. These sound files will be played to a group including both experienced and inexperienced intubators, who will be asked to identify which sounds represent tracheal and esophageal intubation. Overall accuracy will be determined for the group of listeners.

• Study Type: Interventional
• Enrollment: 23
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Manitoba
    • Winnipeg, Manitoba, Canada, R2H 2A6
      • St. Boniface General Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Elective surgery requiring general anesthesia with endotracheal intubation

Exclusion Criteria:

• Anticipated difficult intubation
• Contraindication to esophageal intubation

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Diagnostic
• Allocation: Non-Randomized
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Group accuracy: Correct identification of tube placement based on series of 30 sound files

Collaborators and Investigators

• Sponsor: University of Manitoba
• Investigators: Principal Investigator: Wei-Shuen Tan, BSc(Hon), MD, Department of Anesthesia, University of Manitoba; Principal Investigator: Chris Christodoulou, MBCHB, FRCPC, St. Boniface Hospital

Study record dates

Study Major Dates

• Study Start: September 1, 2006
• Study Completion (Actual): January 1, 2007

Study Registration Dates

• First Submitted: September 19, 2006
• First Submitted That Met QC Criteria: September 19, 2006
• First Posted (Estimate): September 20, 2006

Study Record Updates

• Last Update Posted (Estimate): December 19, 2007
• Last Update Submitted That Met QC Criteria: December 14, 2007
• Last Verified: December 1, 2007

More Information

Terms related to this study

• Keywords: Anesthesia, General; Intubation, Endotracheal
• Other Study ID Numbers: CETINA-2