caa a22 4500 605509689 CHVBK 20210128100642.0 cr unu---uuuuu 210128e20150201xx s 000 0 eng 10.1007/s10877-014-9583-5 doi (NATIONALLICENCE)springer-10.1007/s10877-014-9583-5 Detection of endobronchial intubation by monitoring the CO2 level above the endotracheal cuff [Elektronische Daten] [Shai Efrati, Israel Deutsch, Nathan Weksler, Gabriel Gurman] Early detection of accidental endobronchial intubation (EBI) is still an unsolved problem in anesthesia and critical care daily practice. The aim of this study was to evaluate the ability of monitoring above cuff CO2 to detect EBI (the working hypothesis was that the origin of CO2 is from the unventilated, but still perfused, lung). Six goats were intubated under general anesthesia and the ETT positioning was verified by a flexible bronchoscope. The AnapnoGuard system, already successfully used to detect air leak around the ETT cuff, was used for continuous monitoring of above-the-cuff CO2 level. When the ETT distal tip was located in the trachea, with an average cuff pressure of 15mmHg, absence of CO2 above the cuff was observed. The ETT was then deliberately advanced into one of the main bronchi under flexible bronchoscopic vision. In all six cases the immediate presence of CO2 above the cuff was identified. Further automatic inflation of the cuff, up to a level of 27mmHg, did not affect the above-the-cuff measured CO2 level. Withdrawal of the ETT and repositioning of its distal tip in mid-trachea caused the disappearance of CO2 above the cuff in a maximum of 3min, confirming the absence of air leak and the correct positioning of the ETT. Our results suggest that measurement of the above-the-cuff CO2 level could offer a reliable, on-line solution for early identification of accidental EBI. Further studies are planned to validate the efficacy of the method in a clinical setup. Springer Science+Business Media New York, 2014 Endobronchial nationallicence Intubation nationallicence One lung nationallicence CO2 nationallicence Endotracheal tube nationallicence Efrati Shai Research and Development Unit, Assaf Harofeh Medical Center, Affiliated with the Sackler School of Medicine, Tel-Aviv University, 70300, Zerifin, Israel aut Deutsch Israel Hospitech Respiration Ltd., Petah Tikva, Israel aut Weksler Nathan Division of Anesthesiology and Critical Care, Myney Hayeshuah, Bnei Brak, Ben-Gurion University of the Negev, Beersheba, Israel aut Gurman Gabriel Division of Anesthesiology and Critical Care, Myney Hayeshuah, Bnei Brak, Ben-Gurion University of the Negev, Beersheba, Israel aut Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 19-23 1387-1307 29:1<19 2015 29 10877 https://doi.org/10.1007/s10877-014-9583-5 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s10877-014-9583-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Efrati Shai Research and Development Unit, Assaf Harofeh Medical Center, Affiliated with the Sackler School of Medicine, Tel-Aviv University, 70300, Zerifin, Israel aut NATIONALLICENCE 700 1- Deutsch Israel Hospitech Respiration Ltd., Petah Tikva, Israel aut NATIONALLICENCE 700 1- Weksler Nathan Division of Anesthesiology and Critical Care, Myney Hayeshuah, Bnei Brak, Ben-Gurion University of the Negev, Beersheba, Israel aut NATIONALLICENCE 700 1- Gurman Gabriel Division of Anesthesiology and Critical Care, Myney Hayeshuah, Bnei Brak, Ben-Gurion University of the Negev, Beersheba, Israel aut NATIONALLICENCE 773 0- Journal of Clinical Monitoring and Computing Springer Netherlands 29/1(2015-02-01), 19-23 1387-1307 29:1<19 2015 29 10877