title: Case report: vibration response imaging findings following inadvertent esophageal intubation.
abstract: OBJECTIVE
  We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI).
  
  
  METHODS
  Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally.
  
  
  CONCLUSIONS
  This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation.
authors.affiliation: Department of Medicine, Division of Critical Care Medicine, Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey, Cooper University Hospital, Camden, New Jersey, USA. cinel-ismail@cooperhealth.edu
authors.forename: Ismail
authors.initials: I
authors.lastname: Cinel
authors.forename: Smith
authors.initials: S
authors.lastname: Jean
authors.forename: Christina
authors.initials: C
authors.lastname: Tay
authors.forename: Irwin
authors.initials: I
authors.lastname: Gratz
authors.forename: Edward
authors.initials: E
authors.lastname: Deal
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Parrillo
authors.forename: R Phillip
authors.initials: RP
authors.lastname: Dellinger
mesh_terms: D000368:Aged; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D004947:Esophagus; D005260:Female; D006801:Humans; D007440:Intubation; D007442:Intubation, Intratracheal; D019300:Medical Errors; D012135:Respiratory Sounds / Q000502:physiology; D012815:Signal Processing, Computer-Assisted / Q000295:instrumentation; D014732:Vibration