title: Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions.
abstract: OBJECTIVE
  To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions.
  
  
  METHODS
  Prospective crossover study.
  
  
  METHODS
  University-affiliated hospital.
  
  
  METHODS
  44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures.
  
  
  METHODS
  ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement.
  
  
  METHODS
  The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning.
  
  
  RESULTS
  FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range" positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery.
  
  
  CONCLUSIONS
  Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions.
authors.affiliation: Department of Anesthesia, Wolfson Medical Center affiliated with Tel Aviv Medical School, Holon 58100, Israel.
authors.forename: Nugzar
authors.initials: N
authors.lastname: Rigini
authors.forename: Mona
authors.initials: M
authors.lastname: Boaz
authors.forename: Tiberiu
authors.initials: T
authors.lastname: Ezri
authors.forename: Shmuel
authors.initials: S
authors.lastname: Evron
authors.forename: Dimitry
authors.initials: D
authors.lastname: Trigub
authors.forename: Simon
authors.initials: S
authors.lastname: Jackobashvilli
authors.forename: Alexander
authors.initials: A
authors.lastname: Izakson
mesh_terms: D000005:Abdomen / Q000601:surgery; D000328:Adult; D000368:Aged; D001314:Auscultation; D001999:Bronchoscopy / Q000379:methods*; D018592:Cross-Over Studies; D020878:Device Removal; D005260:Female; D005336:Fiber Optic Technology; D006257:Head; D006785:Hospitals, University; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods*; D013997:Time Factors