Effectiveness of the self-inflating bulb for verification of proper placement of the Esophageal Tracheal Combitube.

Abstract

The esophageal tracheal Combitube (ETC; Sheridan Catheter Corporation, Argyle, NY) is a twin-lumen tube used to establish emergency ventilation. After blind placement, ventilation is performed via the proximal lumen if it is in the esophagus or via the distal lumen if it is in the trachea. This investigation was designed to test the reliability of the self-inflating bulb (SIB) in identifying the location of the ETC and facilitating its proper positioning in anesthetized patients. In Group 1 (n = 26), the ETC was introduced blindly. In Group 2 (n = 20), the tube was placed in the trachea (eight patients) or once in the trachea and once in the esophagus, randomly (12 patients) under direct vision rigid laryngoscopy by the anesthesiologist performing the intubation. In both groups, the efficacy of the SIB in identifying the location of the ETC was tested by a second blinded anesthesiologist. In Group 1, blind insertion of the ETC resulted in esophageal placement in all patients, and in each case was correctly identified. The second anesthesiologist reported no reinflation when the compressed SIB was connected to the distal lumen. When the compressed SIB was connected to the proximal lumen, instantaneous reinflation was observed in 23 patients, delayed reinflation (2-4 s) in two and no reinflation (> 4 s) in one patient. Instantaneous reinflation occurred in these three patients after repositioning of the ETC. In Group 2, the second anesthesiologist correctly identified the location of the ETC in all cases. The results confirm previous findings that blind introduction of the ETC leads to esophageal placement and yields adequate ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)