TY - JOUR
T1 - 318: A MULTICENTER EVALUATION OF A CATHETER TO DECREASE ENDOTRACHEAL TUBE MALPOSITION AFTER INTUBATION
AU - Cohen, Avi
AU - Tan, Laren
AU - Fargo, Ramiz
AU - Anholm, James
AU - Gasho, Christopher
AU - Chopra, Sahil
AU - Hansen, Jennifer
AU - Thapamagar, Suman
AU - Yaqub, Kashif
AU - Huang, Cynthia
AU - Moretta, Dafne
AU - Washburn, Destry
AU - Specht, Lennard
AU - Nguyen, Bryant
PY - 2018/1/1
Y1 - 2018/1/1
N2 - 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.
AB - 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.
UR - https://insights.ovid.com/crossref?an=00003246-201801001-00284
UR - http://Insights.ovid.com/crossref?an=00003246-201801001-00284
U2 - 10.1097/01.ccm.0000528337.02121.5c
DO - 10.1097/01.ccm.0000528337.02121.5c
M3 - Meeting abstract
VL - 46
SP - 141
EP - 141
JO - Critical Care Medicine
JF - Critical Care Medicine
IS - 1
ER -