Left mainstem intubation with digital intubation technique: an unrecognized risk.
To determine whether digital endotracheal intubation predisposes to left mainstem intubation, a prospective, convenience sample of postarrest cadavers in the emergency departments of two university medical centers was used. Six postarrest cadavers were reintubated by the same right-handed intubator using accepted digital intubation technique. Endotracheal tubes (7.5 mm internal diameter) with stylets were configured into an open "J" shape and were inserted to a depth of 30 cm to ensure endobronchial intubation. A portable anteroposterior chest radiograph documented whether the left or right bronchus was intubated. In four of the six cadavers, the endotracheal tube was inserted into the left mainstem bronchus. This represents a greater than 150-fold increase in the rate of left mainstem intubations relative to right mainstem intubations when compared with data from the literature. Digital intubation technique predisposes to left mainstem intubation. Practitioners must have heightened awareness that decreased right-sided breath sounds after digital intubation may represent an easily corrected left mainstem intubation rather than other pathology.
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232.
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SJ
White
D001980:Bronchi; D001995:Bronchography; D002102:Cadaver; D015984:Causality; D004635:Emergency Medicine / Q000193:education; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods*; D007828:Laryngoscopy; D011446:Prospective Studies