Verification of endotracheal tube placement: a comparison of confirmation techniques and devices.

The properly placed endotracheal tube provides the definitive protected airway and is crucial to ensuring adequate ventilation in the event of cardiac arrest, respiratory failure, or significant trauma. Although unrecognized esophageal placement is rapidly fatal, it is not harmful if it is recognized quickly. Nevertheless, many malpractice claims have been prosecuted successfully because practitioners did not recognize that they had improperly placed endotracheal tubes. Recent studies in busy urban EMS systems found that up to 25% of medical or trauma pediatric and adult patients had esophageal intubations on presentation to the emergency department. In the uncontrolled world of EMS, lack of space and visibility often complicate intubation attempts. In addition, movement of patients and vehicles can easily result in the movement of endotracheal tubes. In the hospital setting, whether one is moving a patient for diagnostic medical imaging or rolling down the hallway en route to the critical care unit, tubes can be pulled or moved. If the patient is combative, this possibility increases significantly. In infants and small children with proportionately smaller airways, just the simple flexion or extension of the neck can result in extubation. How, then, do we know if an endotracheal tube is actually in the trachea?