Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions

Study Objective: To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Design: Prospective crossover study. Setting: University-affiliated hospital. Patients: 44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures. Interventions: ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement. Measurements: The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning. Main Results: FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other "out-of-desired range" positions (out of the 3-5 cm range) - one placed too high and 14 placed too low, while 18 were placed within the range of positions. All patients with inappropriate ETT positioning were women (P = 0.005). Age, body mass index, Mallampati grade > 3, thyromental distance < 6 cm, or laryngoscopy grade ≥ 2 were not associated with either inappropriate or critical placement. No episodes of inappropriate or critical positioning were detected by FOB or auscultation at the end of surgery. Conclusions: Early detection and prompt correction of inappropriate ETT positioning after intubation prevented further ETT migration into undesired positions.