title: Assessment of endotracheal tube placement in newborn infants: a randomized controlled trial.
abstract: International resuscitation guidelines recommend clinical assessment and exhaled CO2 to confirm tube placement immediately after intubation. However, exhaled CO2 devices can display false negative results. In comparison, any respiratory function monitor can be used to measure and display gas flow in and out of an endotracheal tube. However, neither method has been examined in detail. We hypothesized that a flow sensor would improve the assessment of tracheal vs esophageal tube placement in neonates with a higher success rate and a shorter time to tube placement confirmation when compared with the use of a quantitative end-tidal CO2 (ETCO2) detector.
  
  
  
  Between December 2013 and September 2014, preterm and term infants requiring endotracheal intubation were eligible for inclusion and randomly allocated to either ETCO2 ('ETCO2 group') or flow sensor ('flow sensor group'). All infants were analyzed according to their group at randomization (that is, analysis was by intention-to-treat).
  
  
  
  During the study period, a total of 110 infants (n=55 for each group) were randomized. Successful endotracheal tube placements were correctly identified in 100% of cases by the flow sensor compared with 72% of cases with the ETCO2 detector within 10 inflations (P<0.05). The median (interquartile range) number of inflations needed to identify successful tube placement was significantly lower in the flow sensor group with 2 (1 to 3) inflations vs 8 (6 to 10) inflations with the ETCO2 detector (P<0.001).
  
  
  
  A flow sensor would improve the assessment of successful endotracheal tube placement with a higher success rate and a shorter time compared with an ETCO2 detector.
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.
authors.forename: S
authors.initials: S
authors.lastname: van Os
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.|Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: P-Y
authors.initials: PY
authors.lastname: Cheung
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Kushniruk
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.|Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: M
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.|Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Aziz
authors.affiliation: Centre for the Study of Asphyxia and Resuscitation, Royal Alexandra Hospital, Alberta Health Services, Edmonton, AB, Canada.|Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: G M
authors.initials: GM
authors.lastname: Schmölzer
mesh_terms: D001944:Breath Tests / Q000379:methods*; D002245:Carbon Dioxide / Q000032:analysis*; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care; D012123:Pulmonary Ventilation; D015203:Reproducibility of Results; D012129:Respiratory Function Tests / Q000295:instrumentation / Q000379:methods
chemical_list: D002245:Carbon Dioxide