title: A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model.
abstract: BACKGROUND
  Endotracheal tube (ETT) malposition is common and an increasing number of non-invasive techniques to aid rapid identification of tube position are available. Electrical impedance tomography (EIT) is advocated as a tool to monitor ventilation.
  
  
  OBJECTIVE
  This study aimed to compare EIT with five other non-invasive techniques for identifying ETT position in a piglet model.
  
  
  METHODS
  Six saline lavage surfactant-depleted piglets were studied. Periods of ventilation with ETT placed in the oesophagus or a main bronchus (MB) were compared with an appropriately placed mid-tracheal ETT. Colorimetric end-tidal CO(2) (Pedi-Cap®), SpO(2) and heart rate, tidal volume (${\rm V}_{{\rm T}_{{\rm ao}} } $) using a hot-wire anemometer at the airway opening, tidal volume using respiratory inductive plethysmography (${\rm V}_{{\rm T}_{{\rm RIP}} } $) and regional tidal ventilation within each hemithorax (EIT) were measured.
  
  
  RESULTS
  Oesophageal ventilation: Pedi-Cap® demonstrated absence of color change. ${\rm V}_{{\rm T}_{{\rm ao}} } $, ${\rm V}_{{\rm T}_{{\rm RIP}} } $, and EIT correctly demonstrated no tidal ventilation. SpO(2) decreased from mean (SD) 96 (2)% to 74 (12)% (P < 0.05; Bonferroni post-test), without heart rate change. MB ventilation: SpO(2) , heart rate and Pedi-Cap® were unchanged compared with mid-tracheal position. ${\rm V}_{{\rm T}_{{\rm ao}} } $ and ${\rm V}_{{\rm T}_{{\rm RIP}} } $ decreased from a mean (SD) 10.8 (5.6) ml/kg and 14.6 (6.2) ml/kg to 5.5 (1.9) ml/kg and 6.4 (2.6) ml/kg (both P < 0.05; Bonferroni post-test). EIT identified the side of MB ventilation, with a mean (SD) 95 (3)% reduction in tidal volume in the unventilated lung.
  
  
  CONCLUSIONS
  EIT not only correctly identified oesophageal ventilation but also localized the side of MB ventilation. At present, no one technique is without limitations and clinicians should utilize a combination in addition to clinical judgement.
authors.affiliation: Neonatal Research, Murdoch Childrens Research Institute, Melbourne, Australia. georg.schmoelzer@me.com
authors.forename: Georg M
authors.initials: GM
authors.lastname: Schmölzer
authors.forename: Risha
authors.initials: R
authors.lastname: Bhatia
authors.forename: Peter G
authors.initials: PG
authors.lastname: Davis
authors.forename: David G
authors.initials: DG
authors.lastname: Tingay
mesh_terms: D000818:Animals; D001944:Breath Tests; D002245:Carbon Dioxide / Q000032:analysis; D004195:Disease Models, Animal; D005547:Foreign Bodies / Q000175:diagnosis*; D006339:Heart Rate; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D010092:Oximetry; D010991:Plethysmography; D010992:Plethysmography, Impedance / Q000379:methods*; D011175:Positive-Pressure Respiration; D011663:Pulmonary Surfactants; D012121:Respiration, Artificial / Q000295:instrumentation*; D013552:Swine; D013990:Tidal Volume
chemical_list: D011663:Pulmonary Surfactants; D002245:Carbon Dioxide