Q; Is equal breath sounds a reliable indicator of proper placement of endotracheal tube ?
A: No
Equal breath sounds can be heard in up to 60% of right main stem intubations 1. A chest radiograph should always be done to confirm proper placement of ETT in ICUs. An end-tidal CO2 monitoring just tells that you are in right tract. Fiberoptic bronchoscopy is a more reliable means of confirming ETT position. Recently, hand held ultrasound is suggested as a quick mean to confirm proper placement of ETT 3. One reliable formula 2 which also found to have good clinical correlation, is
ETT length (incisors to midpoint of trachea, cm) = patient's height (cm)/10+5
Like, if patient's height is 170 cm, ETT should be taped at
170/10 + 5 = 22 cm
Reference: click to get abstract
1. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position.- Chest1989;96:1043-1045.
2. Anaesthesia Intensive Care 1992; 20:156
3. Where’s the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement - Prehosp Disast Med 2004;19(4):366–369.
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