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Chapter 16 - Misplacement of tracheal tubes

from Section 2 - Clinical

Published online by Cambridge University Press:  10 January 2011

By
Om Sanehi
Edited by
Ian Calder  and
Adrian Pearce
Ian Calder
Affiliation:
National Hospital for Neurology and Royal London Hospital
Adrian Pearce
Affiliation:
Guy's and St Thomas' Hospital, London
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Summary

Unrecognised misplacement of a tracheal tube may have disastrous sequelae, and is avoidable. A variety of tests has been devised to do the prompt recognition of misplacement. The characteristic flatus-like sound produced during manual ventilation of a tube placed in the oesophagus is quite different from that produced if the tube is correctly placed, but is not reproduced reliably. Successful identification of tracheal and oesophageal ventilation has been described in small sized studies. Tests to confirm tracheal intubation are listed in this chapter. None of the easily used tests is very reliable, and haemoglobin desaturation is often the reason that bronchial intubation is suspected and detected. There are no specific tests to exclude misplacement in positions such as the retropharyngeal space or intracranial space. However there will be a complete inability to ventilate the lungs, which should become apparent very quickly using the standard tests.

Keywords

nasal continuous positive airway pressureobstructive sleep apnoeaopioid drugstonsillar hypertrophyopioid therapy
Type
Chapter
Information
Core Topics in Airway Management , pp. 151 - 157
Publisher: Cambridge University Press
Print publication year: 2010

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