The esophageal detector device is unreliable when the stomach has been ventilated.

RAPID and accurate diagnosis of the misplacement of an endotracheal tube in the esophagus remains one of the most important problems in anesthesia and intensive care. Clinical signs observed through auscultation, inspection of thoracic excursions, refilling of the breathing bag, or water vapor condensing at the endotracheal tube may be misleading in as many as 30% of patients. ' Although end-tidal carbon dioxide measurement and bronchoscopy remain the gold standards for evaluating the endotracheal tube position, the esophageal detector device (EDD) recently has assumed an important clinical role, with sensitivity and specificity rates for identifying the endotracheal tube position in adults of nearly An EDD may even indicate correct endotracheal tube position in situations in which the end-tidal carbon dioxide concentration fails, such as cardiopulmonary resuscitation or severe bronchospasm.8 Most importantly, misdiagnosis of tubes placed in the esophagus using an EDD in adults is rare.',' Of more than 1,000 reported applications, only two cases have been described in which air could be aspirated from a tube placed in the esophagus: one in a morbidly obese patient' and one in a patient with gastric distension after vigorous attempts to apply mask ventilation.8 Unreliable results also were found in infants younger than 1 yr"' or