EFFECTIVENESS OF THE SELF-INFLATING BULB FOR VERIFICATION OF PROPER PLACEMENT OR THE ESOPHAGEAL TRACHEAL COMBITUBE(R)

The esophageal tracheal Combitube(R) (ETC; Sheridan Catheter Corporati on, Argyle, NY) is a twin-lumen tube used to establish emergency venti lation. After blind placement, ventilation is performed via the proxim al 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 (SIE) in identifying the location of the ET C 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 t rachea and once in the esophagus, randomly (12 patients) under direct vision rigid laryngoscopy by the anesthesiologist performing the intub ation. In both groups, the efficacy of the SIE in identifying the loca tion of the ETC was tested by a second blinded anesthesiologist. In Gr oup 1, blind insertion of the ETC resulted in esophageal placement in all patients, and in each case was correctly identified. The second an esthesiologist reported no reinflation when the compressed SIE was con nected to the distal lumen. When the compressed SIB was connected to t he proximal lumen, instantaneous reinflation was observed in 23 patien ts, delayed reinflation (2-4 s) in two and no reinflation (> 4 s) in o ne patient. Instantaneous reinflation occurred in these three patients after repositioning of the ETC. In Group 2, the second anesthesiologi st correctly identified the location of the ETC in all cases. The resu lts confirm previous findings that blind introduction of the ETC leads to esophageal placement and yields adequate ventilation. Furthermore, the SIE can easily and quickly identify the location of the ETC and f acilitates its positioning using a simple algorithm. This may be of im portance if the ETC is used in patients whose lungs cannot be ventilat ed by mask and whose trachea cannot be intubated.