title: Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position.
abstract: We consecutively and prospectively studied 219 critically ill patients to evaluate the accuracy of the physical examination in assessing ETT position and the appropriateness of taking routine chest x-ray films after intubation in the ICU. As a result of x-ray findings, 14 percent of the patients required ETT repositioning, and 5 percent had main-stem intubations. Endobronchial intubation was more common in females than in males, and frequently occurred after emergency intubations. Sixty percent of the main-stem intubations occurred despite the presence of equal breath sounds on examination. Techniques to minimize the risk of tube malposition, such as cuff ballottement in the suprasternal notch and referencing the ETT centimeter markings, were not completely reliable. This study confirms the unreliability of the physical examination to assess ETT position. Chest x-ray films after intubation are indicated to verify tube position, particularly after emergency intubations. Other techniques such as use of a lighted stylet require evaluation to determine whether they are more cost-effective in verifying ETT placement in patients who have no other indication for postintubation x-ray films.
authors.affiliation: Department of Surgery, University of California, San Francisco.
authors.forename: W
authors.initials: W
authors.lastname: Brunel
authors.forename: D L
authors.initials: DL
authors.lastname: Coleman
authors.forename: D E
authors.initials: DE
authors.lastname: Schwartz
authors.forename: E
authors.initials: E
authors.lastname: Peper
authors.forename: N H
authors.initials: NH
authors.lastname: Cohen
mesh_terms: D003362:Cost-Benefit Analysis; D003955:Diagnostic Tests, Routine; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D013902:Radiography, Thoracic