Esophageal detector devices and children

Letters

CJEM 1999;1(3):162-163

To the editor:

Rhine and Morrow¹ suggest that the esophageal detector device (EDD) is a useful adjunct for confirming tube placement in adults. It may be less accurate in young children.

The EDD was evaluated in 20 children under 1 year of age undergoing elective surgery.² All were intubated and had a second ET tube placed into their esophagus. An observer, blind to tube placement, was then asked to use a modified EDD and aspirate from one of the tubes. Esophageal tube placement was identified correctly in 7 of 10 cases and tracheal tube placement in 8 of 10 cases, giving an overall failure rate of 25%. The authors suggest that failure to recognize esophageal placement could occur if gastroesophageal reflux or hiatus hernia allow gas to be aspirated from the stomach, if the esophageal tube is passed into the stomach, or if the esophagus doesn’t readily collapse and form a seal around the tube. Failure to confirm tracheal tube placement could occur if young childrens’ more flexible tracheal rings fail to hold the airway rigidly open or if the tracheal mucosa collapses over the tube when negative intraluminal pressure is applied.

Relying on the EDD to confirm proper placement of an ET tube in young children may be dangerous.

Joel Lexchin, MD
Toronto, Ont.
joel.lexchin@utoronto.ca

References

1. Rhine DJ, Morrow DJ. Is the esophageal detector device or end-tidal CO2 measurement superior in confirming endotracheal tube placement? CJEM 1999;1(2):103-4.
2. Haynes SR, Morton NS. Use of the oesophageal detector device in children under one year of age. Anaesthesia 1990;45:1067-9.