title: Bronchial intubation could be detected by the visual stethoscope techniques in pediatric patients.
abstract: BACKGROUND
  We created a system that allows the visualization of breath sounds (visual stethoscope).
  
  
  OBJECTIVE
  We compared the visual stethoscope technique with auscultation for the detection of bronchial intubation in pediatric patients.
  
  
  METHODS
  In the auscultation group, an anesthesiologist advanced the tracheal tube, while another anesthesiologist auscultated bilateral breath sounds to detect the change and/or disappearance of unilateral breath sounds. In the visualization group, the stethoscope was used to detect changes in breath sounds and/or disappearance of unilateral breath sounds. The distance from the edge of the mouth to the carina was measured using a fiberoptic bronchoscope.
  
  
  RESULTS
  Forty pediatric patients were enrolled in the study. At the point at which irregular breath sounds were auscultated, the tracheal tube was located at 0.5 ± 0.8 cm on the bronchial side from the carina. When a detectable change of shape of the visualized breath sound was observed, the tracheal tube was located 0.1 ± 1.2 cm on the bronchial side (not significant). At the point at which unilateral breath sounds were auscultated or a unilateral shape of the visualized breath sound was observed, the tracheal tube was 1.5 ± 0.8 or 1.2 ± 1.0 cm on the bronchial side, respectively (not significant).
  
  
  CONCLUSIONS
  The visual stethoscope allowed to display the left and the right lung sound simultaneously and detected changes of breath sounds and unilateral breath sound as a tracheal tube was advanced.
authors.affiliation: Department of Anesthesiology and Intensive Care, Hamamatsu University School of Medicine, Hamamatsu, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Kimura
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Soichiro
authors.initials: S
authors.lastname: Mimuro
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Makino
authors.forename: Shigehito
authors.initials: S
authors.lastname: Sato
mesh_terms: D000769:Anesthesia, Inhalation; D001314:Auscultation; D001980:Bronchi / Q000502:physiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation*; D008297:Male; D019300:Medical Errors / Q000009:adverse effects; D009055:Mouth / Q000033:anatomy & histology; D012135:Respiratory Sounds; D019023:Stethoscopes