The Science Journal of the American Association for Respiratory Care

2009 OPEN FORUM Abstracts

RADIOGRAPHIC COMPARISON OF ENDOTRACHEAL TUBE VISUALIZATION

Frank M. Freihaut1, Randeep S. Jawa2; 1Respiratory Care, The Nebraska Medical Center, Omaha, NE; 2Surgery, University of Nebraska Medical Center, Omaha, NE

Background: Critical Care physicians at a 700 bed tertiary care medical center expressed concerns regarding the ability to visualize endotracheal tube (ETT) placement on chest radiographs. Radiographic images are viewed via a Picture Archiving Communication System (PACS) on standard computer monitors at the patient bedside. The medical center used two brands of ETT. The following study was completed to determine if one ETT is significantly easier to view within a controlled set of parameters. Method: The two standard tubes used were a Sheridan/ HVT cuffed size 7.5 ETT and a Mallinkrodt Hi-Lo cuffed size 7.5 ETT. A Sheridan Preformed size 6.5 ETT was included as an additional variable because of its limited use as a “specialty” tube in this facility. The three tubes were randomly placed on the bottom of a plastic container filled with 8 inches of water to simulate body tissue. Four radiographic images were taken and comprised the “visuals” for scoring. A blinded “Visualization Survey” was conducted using the four different images of each of the ETT. The exact same artifact affected all the images. Physicians were individually surveyed, (24 Residents, 19 Attendings, and 7 Fellows) utilizing a Likert Scale to rank the visibility. A rating of 5 indicated the ETT had “Ideal” visualization and a rating of 1 indicated the ETT was not able to be seen. Weighted averages of the Likert scale ratings were calculated and Chi-squared method statistical analysis were performed. Results: Initial analysis compared all 3 ETT and demonstrated a significant visibility difference. (See table). We then compared the two best visualized ETT and also confirmed that there was a significant difference. Both analysis showed a P value of less than 0.001. Conclusions: The results of this in vitro blinded observational survey determined that the Malinkrodt Hi-Lo ETT is better visualized when compared with the Sheridan/HVT and Sheridan Preformed under the conditions tested. The medical center now uses the Malinkrodt Hi-Lo tube as it’s primary ETT for all standard tracheal intubations. Sponsored Research - None

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