title: Verification of endotracheal tube placement by prehospital providers: is a portable fiberoptic bronchoscope of value?
abstract: BACKGROUND
  This study was designed to examine whether a handheld, battery-operated fiberoptic bronchoscope (FOB) used to verify endotracheal tube (ETT) placement would be as sensitive and specific as other modes and whether a combination of multiple modes would further enhance the sensitivity and specificity of ETT placement verification.
  
  
  METHODS
  An academic hospital-based air medical program.
  
  
  METHODS
  This was a prospective, randomized study examining surgical patients undergoing general endotracheal anesthesia. Eighteen critical care transport (CCT) nurses, previously unfamiliar with FOB, were asked to identify intratracheal and intraesophageal ETTs by using misting, end-tidal carbon dioxide concentration (ETCO(2)), and FOB alone or with a combination of all three modes. The sensitivity and specificity of single and multimode verification were calculated and compared.
  
  
  RESULTS
  Comparison of ETT verification by single mode alone revealed a rank order of sensitivity with ETCO(2) (0.97) > FOB (0.87) > misting (0.84), whereas all three modes had similar specificities (0.93-0.94). However, the use of the three-mode combination revealed a sensitivity and specificity of 1.0.
  
  
  CONCLUSIONS
  As a single mode for ETT verification, use of a handheld, battery-operated FOB device allowed for direct visualization and had an 87% sensitivity and 93% specificity. When combined with misting and ETCO(2), FOB allowed 100% successful verification of ETT placement.
authors.affiliation: Department of Anesthesia, Stanford University Medical Center, Stanford, California, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Angelotti
authors.forename: Eric L
authors.initials: EL
authors.lastname: Weiss
authors.forename: Hendrikus J M
authors.initials: HJ
authors.lastname: Lemmens
authors.forename: John
authors.initials: J
authors.lastname: Brock-Utne
mesh_terms: D017732:Air Ambulances; D000770:Anesthesia, Endotracheal / Q000295:instrumentation; D020680:Bronchoscopes / Q000191:economics / Q000592:standards*; D002140:California; D002245:Carbon Dioxide / Q000032:analysis; D003124:Colorimetry; D016529:Emergency Nursing; D004638:Emergency Treatment / Q000191:economics / Q000295:instrumentation*; D004867:Equipment Design; D005336:Fiber Optic Technology / Q000191:economics / Q000295:instrumentation*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D019300:Medical Errors / Q000517:prevention & control; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013990:Tidal Volume
chemical_list: D002245:Carbon Dioxide