Evaluating the Practice of Repositioning Endotracheal Tubes in Neonates and Children Based on Radiographic Location.
Pediatr Crit Care Med
; 20(11): 1057-1060, 2019 11.
Article
em En
| MEDLINE
| ID: mdl-31206500
ABSTRACT
OBJECTIVES:
Chest radiographs are commonly performed in the ICU setting to confirm the position of the endotracheal tube. The purpose of this study was to evaluate the practice and accuracy of repositioning endotracheal tubes in the pediatric population based on chest radiograph.DESIGN:
Retrospective review of patient's medical record and chest radiograph.SETTING:
Single-institution, academic children's hospital. PATIENTS PICU and cardiothoracic ICU patients who had repositioning of their endotracheal tube from September 1, 2016, to September 1, 2017. MEASUREMENTS AND MAINRESULTS:
Chest radiograph before and after endotracheal tube repositioning were examined measuring the distance from the endotracheal tube tip to carina. A total of 183 endotracheal tube repositionings were assessed. Twenty-nine percent of endotracheal tube repositionings resulted in a persistently malpositioned endotracheal tube, requiring another intervention. For intended endotracheal tube repositioning of ± 2.0 cm, the actual change measured compared to intended adjustment was a median of 0.7 cm (interquartile range, 0.35-1.1 cm). For intended ± 1.5 cm, the median difference was 0.4 cm (interquartile range, 0.16-0.90 cm). For intended ± 1.0 cm, the median difference was 0.5 cm (interquartile range, 0.20-0.90 cm). For intended ± 0.5 cm, the median difference was 0.3 cm (interquartile range, 0.2-0.88 cm). When the head was malpositioned the difference from intended endotracheal tube repositioning to actual was median 0.70 cm (interquartile range, 0.40-1.1 cm), this was significantly higher than when the head was in a good positionCONCLUSIONS:
When repositioning endotracheal tubes based on chest radiograph, there is a significant difference between intended and actual adjustment with great variability. Avoiding very small repositionings (± 0.5 cm) and standardizing head position prior to daily chest radiograph may reduce these errors.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Intubação Intratraqueal
Tipo de estudo:
Evaluation_studies
/
Observational_studies
Limite:
Adolescent
/
Adult
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Child
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Child, preschool
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Humans
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Infant
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Newborn
Idioma:
En
Ano de publicação:
2019
Tipo de documento:
Article