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PEDIATRIC ANESTHESIA

Endobronchial Intubation Causes an Immediate Increase in Peak Inflation Pressure in Pediatric Patients

Department of Anesthesiology, The University of Texas Medical School at Houston, Houston, Texas

Address correspondence and reprint requests to Samia N. Khalil, MD, 6431 Fannin, MSB 5.020, Houston, TX 77030. Address e-mail to skhalil{at}anes1.med.uth.tmc.edu

Our purpose was to determine whether endobronchial intubation always causes an immediate increase in peak inflation pressure and, if so, the magnitude of the increase. Fourteen children scheduled for central line placement for prolonged antibiotic administration comprised the study group. After routine premedication and induction of anesthesia (halothane in oxygen), an endotracheal tube was inserted, and its position was verified by auscultation and fluoroscopy. Children were mechanically ventilated using a preset volume pressure-limited ventilator with a 5-L fresh gas flow. All children received a constant tidal volume using a similar circuit, similar tubing, and a similar compression volume. The lowest peak inflation pressure to deliver a tidal volume of 15 mL/kg was used. After adjusting the respiratory rate (end-tidal CO₂ 30 mm Hg) and anesthetic level (halothane end-tidal 1.2%), the peak inflation pressure at this endotracheal position was re-corded. The endotracheal tube was advanced into a bronchus, the position was verified as above, and peak inflation pressure was recorded. The endobronchial tube was then pulled back into the trachea, and placement of the central line proceeded. The peak inflation pressure at the endobronchial position was significantly greater than the peak inflation pressure at the endotracheal position (P < 0.0001). The increase was instantaneous at the endobronchial position. Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.

Implications: Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.

This article has been cited by other articles:

				E. A. Harris, K. L. Arheart, and D. H. Penning Endotracheal tube malposition within the pediatric population: a common event despite clinical evidence of correct placement: [Mauvais positionnement du tube endotracheal dans une population pediatrique : un evenement courant malgre des donnees cliniques suggerant un positionnement correct] Can J Anesth, October 1, 2008; 55(10): 685 - 690. [Abstract] [Full Text] [PDF]

				A. Mahajan, N. Hoftman, A. Hsu, R. Schroeder, and S. Wald Continuous Monitoring of Dynamic Pulmonary Compliance Enables Detection of Endobronchial Intubation in Infants and Children Anesth. Analg., July 1, 2007; 105(1): 51 - 56. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999