Patients worldwide die every year from unrecognised oesophageal intubation, which is an avoidable complication of airway management usually resulting from human error. Unrecognised oesophageal intubation can occur in any patient of any age whenever intubation occurs regardless of the seniority or experience of the airway practitioner or others involved in the patient's airway management. The tragic fact is that it continues to happen despite improvements in monitoring, airway devices, and medical education. We review these improvements with strategies to eliminate this problem.
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| http://dx.doi.org/10.1016/j.bja.2022.08.027 | DOI Listing |
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Article Synopsis
- Despite national efforts to highlight the importance of capnography for confirming tracheal intubation, deaths from unrecognized esophageal intubation persist, prompting the adoption of a two-person verbal check during the intubation process.
- In a study across two hospitals, one implemented a one-step check and the other a two-step check, collecting feedback from anaesthetists and assistants via anonymous questionnaires throughout the process.
- The majority of participants felt that the two-person checks enhanced communication and teamwork, with high support for continued use; 82% of intubators and 94% of assistants intended to use this method for future intubations.
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Oesophageal intubations are more common than may be realised and can potentially cause significant patient harm even if promptly identified and corrected. Reports of morbidity due to unrecognised oesophageal intubation continue to present in coroner and media reports. Therefore, it would be helpful to identify mechanisms to prevent these events and implement strategies to avoid and identify incorrect endotracheal tube placement.
View Article and Find Full Text PDFThe Theatre Recovery and Anaesthetic Nurse Capnography Education (TRACE) project is a multidisciplinary quality improvement project. The overall aim is to educate anaesthetic and recovery nurses on the correct use of capnography and educate non-consultant hospital doctors on the guidelines on from the Project for Universal Management of Airways group. This project addresses technical aspects of task performance such as correct waveform identification and interpretation, troubleshooting abnormal waveforms and establishing routine checks of capnography both pre-induction and post-intubation.
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