318: A MULTICENTER EVALUATION OF A CATHETER TO DECREASE ENDOTRACHEAL TUBE MALPOSITION AFTER INTUBATION

Avi Cohen, Laren Tan, Ramiz Fargo, James Anholm, Christopher Gasho, Sahil Chopra, Jennifer Hansen, Suman Thapamagar, Kashif Yaqub, Cynthia Huang, Dafne Moretta, Destry Washburn, Lennard Specht, Bryant Nguyen

Research output: Contribution to journalMeeting abstractpeer-review

Abstract

Learning Objectives: Endotracheal tube (ETT) malposition is associated with high incidence of adverse outcomes. Our objective was to demonstrate that the use of a minimally invasive and disposable catheter (NEMO GaugeTM, Ciel Medical, San Carlos, CA) can reduce ETT malposition rate. Methods: This study is a 3-center, prospective observational cohort of patients who were admitted to the medical intensive care unit requiring rapid sequence intubation. The catheter was inserted into the ETT post-intubation and immediately before obtaining a chest radiograph. When introduced into the ETT, the catheter has color markers that qualitatively determine if the distal ETT is positioned 2-5 cm from the carina. The ETT was adjusted if determined necessary. The chest radiograph was then used to confirm ETT position, with further adjustments per clinician judgement. Malposition of the ETT was defined by the distal ETT outside of 2-5 cm above the carina. Results: Sixty-nine patients were enrolled from August 15, 2016 to July 14, 2017, age 56.2 +/- 19.5 years, with body mass index 31.1 +/- 13.8 kg/m2. Prior to obtaining the chest radiograph, the catheter alerted the clinician to reposition the ETT in 40 (58.0%) patients. Without the catheter, the ETT malposition rate would have been 33.3%. By using the catheter, the rate of malposition decreased to 7.0%, with the distal ETT position at 3.7 +/- 1.2 cm above the carina. There was no right main bronchus intubation. No complication related to the catheter occurred. The operator time for catheter use was < 1 minute by 35 (51%) clinicians, 1-2 minutes by 19 (28%) clinicians, with the longest time of 9-10 minutes reported by 1 clinician (1%). However, the time from order for the chest radiograph to its completion was 44 +/- 36 minutes (range 1 to 172 minutes). Conclusions: With use of the NEMO GaugeTM, the ETT malposition rate was reduced by 79.0% without any complications. This catheter-based system was safe and potentially may avoid chest radiograph post-intubation.
Original languageAmerican English
Pages (from-to)141-141
Number of pages1
JournalCritical Care Medicine
Volume46
Issue number1
DOIs
StatePublished - Jan 1 2018

Disciplines

  • Medicine and Health Sciences
  • Anesthesiology
  • Critical Care

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