Esophageal detector devices

Letters

CJEM 2000;2(1):9

To the editor:

I was pleased to read CJEM’s recent Journal Club article¹ comparing esophageal detector devices (EDD) and end-tidal CO2 monitoring (ETCO2). I agree that EDD is cheap, easy to use, portable and superior to ETCO2 in arrest situations, but would like to caution that there are clinical factors that may give rise to false-negative EDD results.

We studied the EDD in 300 patients and found 2 cases where it falsely suggested esophageal tube placement. One of these patients was obese and the other had bronchospasm, causing the EDD to reinflate very slowly despite appropriate position in the airway.

Despite the availability of ETCO2 monitoring in our operating room, I continue to use EDD and teach the residents about its usefulness. Although most emergency rooms use colorimetric or waveform (CO2) technology, I believe that EDD has an important role in the detection of endotracheal tube position and I commend Drs. Rhine and Morrow for their review of this topic.

C. Ananthanarayan, MD
Department of Anaesthesia
Mount Sinai Hospital
Toronto, Ont.

Reference

1. Rhine DJ, Morrow DJ. Is the esophageal detector device or end-tidal CO2 measurement superior in confirming endotracheal tube placement? CJEM 1999;1:103-4.