title: A randomized controlled trial of capnography in the correction of simulated endotracheal tube dislodgement.
abstract: OBJECTIVE
  Unrecognized dislodgement of an endotracheal tube (ETT) during the transport of an intubated patient can have life-threatening consequences. Standard methods to monitor these patients, such as pulse oximetry and physical examination, are both subject to inaccuracies with patient movement and ambient noise. Capnography provides a continuous and objective measure of ventilation that can alert a provider immediately to an airway problem. The objective of this study was to determine through simulation if capnography decreases time to correction of dislodged ETTs during the transport of intubated patients, in comparison to standard monitoring.
  
  
  METHODS
  Paramedics and paramedic students were randomized as to whether or not they had capnography available to them in addition to standard monitoring during a simulated scenario. In the scenario, subjects monitored an intubated baby who subsequently experiences a dislodgement of the ETT during interfacility transport. Time to correction of the ETT dislodgement was the primary outcome. The secondary outcome was correction of dislodgement prior to decline in pulse oximetry.
  
  
  RESULTS
  Fifty-three subjects were enrolled in the study, with complete data on 50 subjects. Median time to correction of ETT dislodgement was 2.02 minutes (95% confidence interval [CI] = 1.22 to 4.12 minutes) for the capnography group versus 4.00 minutes (95% CI = 3.35 to 5.50 minutes) in the standard monitoring group (p = 0.05). Forty-eight percent of subjects using capnography corrected the ETT dislodgement prior to decline in pulse oximetry compared with 12% of controls (p = 0.01). There were no differences in time to correction of dislodgement based on years of experience, perceived comfort, reported adequacy of teaching, or past use of capnography.
  
  
  CONCLUSIONS
  The addition of capnography to standard monitoring significantly improves recognition of ETT dislodgement and reduces the time to correction of dislodged ETTs by prehospital providers in a simulated pediatric transport setting.
authors.affiliation: Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA. Melissa.langhan@yale.edu
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Langhan
authors.forename: Kevin
authors.initials: K
authors.lastname: Ching
authors.forename: Veronika
authors.initials: V
authors.lastname: Northrup
authors.forename: Michelle
authors.initials: M
authors.lastname: Alletag
authors.forename: Payal
authors.initials: P
authors.lastname: Kadia
authors.forename: Karen
authors.initials: K
authors.lastname: Santucci
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
mesh_terms: D019296:Capnography; D003198:Computer Simulation; D004632:Emergency Medical Services; D004868:Equipment Failure; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D010092:Oximetry; D014187:Transportation of Patients