title: Novel device (AirWave) to assess endotracheal tube migration: a pilot study.
abstract: BACKGROUND
  Little is known about endotracheal tube (ETT) migration during routine care among critically ill patients. AirWave is a novel device that uses sonar waves to measure ETT migration and obstructions in real time. The aim of the present study is to assess the accuracy of the AirWave to evaluate ETT migration. In addition, we determined the degree of variation in ETT position and tested whether more pronounced migration occurs in specific clinical scenarios.
  
  
  METHODS
  After institutional review board approval, we included mechanically ventilated patients from February 2012 to May 2012. A chest radiography (CXR) was obtained at baseline and 24 hours when clinically indicated. The ETT distance at the lips was recorded at baseline and every 4 hours. The AirWave system continuously recorded ETT position changes from baseline, and luminal obstructions.
  
  
  RESULTS
  A total of 42 patients (age: 61 [SD ±13] years, men: 52%) were recruited. A total of 19 patients had measurements of ETT migration at 24 hours by the 3 methodologies used in this study. The mean (SD) of the ETT migration at 24 hours was +0.04 (1.2), -0.42 (0.7) and +0.34 (1.81) cm when measured by portable CXR, ETT distance at the teeth and AirWave device, respectively. Bland-Altman analysis of tube migration at 24 hours comparing the AirWave with CXR readings showed a bias of 0.1 cm with 95% limit of agreement of -3.8 and +4.3 cm. Comparison of tube migration at 24 hours determined by AirWave with ETT distance at the lips revealed a bias of -0.4 with 95% limit of agreement -3.7 to +3 cm, similar to the values observed between CXR and ETT distance at the lips (bias of -0.3 cm, 95% limit of agreement of -3.4 to +2.8 cm). Factors associated with ETT migration at 24 hours were ETT size and initial measurement from ETT tip to carina by portable CXR. AirWave detected in eight patients some degree of ETT obstruction (30% ± 9.6%) that resolved with prompt ETT catheter suction.
  
  
  CONCLUSIONS
  The AirWave may provide useful information regarding ETT migration and obstruction in real time.
authors: Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Gustavo Cumbo
authors: GC
authors: Nacheli
authors: Manish
authors: M
authors: Sharma
authors: Xiaofeng
authors: X
authors: Wang
authors: Amit
authors: A
authors: Gupta
authors: Jorge A
authors: JA
authors: Guzman
authors: Adriano R
authors: AR
authors: Tonelli
mesh_terms: D016638:Critical Illness; D003430:Cross-Sectional Studies; D004867:Equipment Design; D005260:Female; D005548:Foreign-Body Migration / Q000175:diagnosis*; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000295:instrumentation*; D010865:Pilot Projects; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012121:Respiration, Artificial; D013016:Sound
keywords: AirWave; Endotracheal tube; Migration; Obstruction
references: Intensive Care Med. 2002 Jun;28(6):701-4
references: 12107674
references: Crit Care. 2006 Feb;10(1):R11
references: 16420655
references: J Clin Nurs. 1996 Nov;5(6):389-98
references: 8981862
references: Am J Respir Crit Care Med. 2000 Jun;161(6):1912-6
references: 10852766
references: Anesth Analg. 2001 Feb;92(2):375-8
references: 11159235
references: Crit Care Clin. 2007 Jul;23(3):539-73
references: 17900484
references: Nurs Stand. 2003 Nov 12-18;18(9):47-53; quiz 54-5
references: 14649194
references: Chest. 2003 May;123(5):1607-14
references: 12740281
references: Anesthesiol Clin North Am. 2001 Dec;19(4):813-39
references: 11778382
references: Chest. 1990 Jul;98(1):165-9
references: 2361385
references: AJR Am J Roentgenol. 1999 Nov;173(5):1357-9
references: 10541118
references: Aust Crit Care. 2005 Nov;18(4):158, 160-5
references: 18038537
references: Am J Respir Crit Care Med. 1998 Apr;157(4 Pt 1):1131-7
references: 9563730
references: Crit Care Med. 2007 May;35(5 Suppl):S173-7
references: 17446776
references: Resuscitation. 2008 Jan;76(1):11-6
references: 17719166
references: Int J Med Robot. 2009 Sep;5(3):332-40
references: 19449314
references: Crit Care Med. 1995 Jul;23(7):1306-8
references: 7600843
references: Respir Care. 1987 Feb;32(2):81-4
references: 10317847
references: Crit Care. 2000;4(1):50-3
references: 11056745
references: AJR Am J Roentgenol. 1976 Sep;127(3):433-4
references: 183529
references: Crit Care Med. 2004 Sep;32(9 Suppl):S374-7
references: 15508663
references: Crit Care Med. 1976 Jan-Feb;4(1):8-12
references: 1253616
references: Anesthesiology. 2002 Jul;97(1):148-56
references: 12131116
references: J Emerg Med. 2001 Apr;20(3):231-9
references: 11267810
references: Anesth Analg. 1998 Jun;86(6):1171-6
references: 9620498
references: Crit Care Nurse. 1995 Apr;15(2):57-65
references: 7774248
references: J Emerg Med. 2001 Apr;20(3):223-9
references: 11267809