title: Improving detection by pediatric residents of endotracheal tube dislodgement with capnography: a randomized controlled trial.
abstract: OBJECTIVE
  The authors sought to determine if capnography could improve time to correction of a simulated endotracheal tube (ETT) dislodgement by pediatric residents.
  
  
  METHODS
  Pediatric residents attended a didactic session that included interpretation of capnography. A randomized controlled study was then performed using patient simulators. Residents were randomized to standard monitoring (control group) or standard monitoring plus capnography (intervention group). The primary outcome was time to correction of ETT dislodgement. Correction of dislodgement prior to decline in pulse oximetry was our secondary outcome.
  
  
  RESULTS
  Twenty-seven subjects completed the simulation. Subjects in the intervention group corrected the ETT dislodgement faster than those in the control group (2.38 minutes vs 3.92 minutes, P = .02). There were no differences in time to correction based on postgraduate year, clinical experiences, or comfort with capnography. Two subjects corrected the dislodgement prior to changes in pulse oximetry, both from the intervention group. Fifty-nine percent of subjects had seen capnography used in the past and 82% felt very or somewhat comfortable with capnography.
  
  
  CONCLUSIONS
  Capnography decreased time to correction of ETT dislodgement by pediatric residents. Capnography should be considered as an essential monitoring device for intubated patients to enhance patient safety.
authors.affiliation: Department of Pediatrics, 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: Marc
authors.initials: M
authors.lastname: Auerbach
authors.forename: Alla N
authors.initials: AN
authors.lastname: Smith
authors.forename: Lei
authors.initials: L
authors.lastname: Chen
mesh_terms: D019296:Capnography / Q000379:methods*; D002648:Child; D002983:Clinical Competence; D005548:Foreign-Body Migration / Q000175:diagnosis*; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007442:Intubation, Intratracheal; D010092:Oximetry; D016544:Patient Simulation; D015203:Reproducibility of Results; D014132:Trachea