Electrical impedance tomography for verification of correct endotracheal tube placement in paediatric patients: a feasibility study.

Acta anaesthesiologica Scandinavica

PubMedID: 23750708

Steinmann D, Engehausen M, Stiller B, Guttmann J. Electrical impedance tomography for verification of correct endotracheal tube placement in paediatric patients: a feasibility study. Acta Anaesthesiol Scand. 2013;57(7):881-7.
BACKGROUND
Endotracheal tubes (ETTs) are frequently used in paediatric anaesthesia. Correct placement is crucial. The aim of this study was to evaluate electrical impedance tomography (EIT) for guiding and confirmation of paediatric ETT placement. In a retrospective analysis of stored EIT data, distribution of ventilation between left and right lung was used to verify correct paediatric ETT placement.

METHODS
Left and right lung ventilation was studied by EIT in 18 paediatric patients (median age: 53 months) requiring anaesthesia and endotracheal intubation. EIT was recorded before induction of anaesthesia, during mask ventilation, during ETT placement (including deliberate mainstem intubation), and after ETT repositioning according to the formula: ETT intubation depth (cm)?=?3× ETT internal diameter (mm) or the mainstem intubation method (withdrawing the ETT 2?cm). Final ETT position was confirmed by fluoroscopy.

RESULTS
Following deliberate mainstem intubation, distribution of ventilation to the right lung was unequivocally demonstrated by EIT. Homogeneous distribution of ventilation between left and right lung monitored with EIT correlated in each patient with correct endotracheal ETT placement. The distribution of left and right lung ventilation differed significantly (P?
CONCLUSION
This study demonstrates that EIT enables non-invasive recognition of correct ETT placement. Homogeneous right-left-lung ventilation is an indicator for correct ETT placement.