Repositioning endotracheal tubes in the intensive care unit: depth changes poorly correlate with postrepositioning radiographic location.
BACKGROUND
Suboptimal positioning of endotracheal tubes (ETs) is often identified on routine chest radiographs prompting adjustment. The accuracy of ET adjustments based on tube measurement markings at the incisors has not been reported.


METHODS
We performed a 1-year prospective observational study of all surgical intensive care unit patients requiring repositioning of their ET based on chest x-ray (CXR) study. The ET was repositioned by a respiratory therapist using tube markings at the incisors, and follow-up CXR images were obtained within 2 hours. ET tube locations were compared with the planned intervention. Mean, median, interquartile range (IQR) and [chi]2 results are reported.


RESULTS
Fifty-five patients met inclusion criteria and had a complete set of data (80% male). ET advancement was the most commonly required intervention (80%). For advancement, the median starting position was 7.10 cm (IQR, 2.20 cm) from the carina, with a median planned advancement of 2.00 cm. The actual advancement was a median of 1.15 cm, achieving 57.5% of the goal. Patients requiring ET withdrawal were more likely female (8 of 11, p < 0.001). For the withdrawal group, the median starting position was 0.70 cm (IQR, 1.05 cm) from the carina with a planned median withdrawal of 2.00 cm (IQR, 0.75 cm). The actual withdrawal was a median of 1.00 cm, achieving 50.0% of the goal. Overall, the mean difference between the planned and actual intervention was 1.55 cm (95% confidence interval, 1.16-1.95 cm) differing by a mean of 40% from the planned intervention (95% confidence interval, 29.0-51.0%). There was no correlation between the original location or the planned intervention and the accuracy of the intervention. In three cases, the ET moved opposite of the planned intervention.


CONCLUSIONS
ET repositioning based on measurement at the incisors is inaccurate and the magnitude of the intervention does not correlate with the degree of error. Repositioning of ETs based on measurements at the incisors should be abandoned, or follow-up CXR images should be obtained.
Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, Yale School of Medicine, New Haven, Connecticut 06520-8062, USA.
Ming-Li
ML
Wang
Kevin M
KM
Schuster
Bishwajit
B
Bhattacharya
Adrian A
AA
Maung
Lewis J
LJ
Kaplan
Kimberly A
KA
Davis
D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000379:methods; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D015999:Multivariate Analysis; D056888:Patient Positioning; D011446:Prospective Studies; D013902:Radiography, Thoracic; D019233:Retreatment; D018570:Risk Assessment; D014132:Trachea / Q000000981:diagnostic imaging*