Endobronchial intubation causes an immediate increase in peak inflation pressure in pediatric patients

Our purpose was to determine whether endobronchial intubation always causes an immediate increase in peak inflation pressure and, if so, the magnitude of the increase. Fourteen children scheduled for central line placement fo r prolonged antibiotic administration comprised the study group. After rout ine premedication and induction of anesthesia (halothane in oxygen), an end otracheal tube was inserted, and its position was verified by auscultation and fluoroscopy. Children were mechanically ventilated using a preset volum e pressure-limited ventilator with a 5-L fresh gas flow. All children recei ved a constant tidal volume using a similar circuit, similar tubing, and a similar compression volume. The lowest peak inflation pressure to deliver a tidal volume of 15 mL/kg was used. After adjusting the respiratory rate (e nd-tidal CO2 30 mm Hg) and anesthetic level (halothane end-tidal 1.2%), the peak inflation pressure at this endotracheal position was recorded. The en dotracheal tube was advanced into a bronchus, the position was verified as above, and peak inflation pressure was recorded. The endobronchial tube was then pulled back into the trachea, and placement of the central line proce eded. The peak inflation pressure at the endobronchial position was signifi cantly greater than the peak inflation pressure at the endotracheal positio n (P < 0.0001). The increase was instantaneous at the endobronchial positio n. Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation. Implic ations: Monitoring peak inflation pressure while inserting an endotracheal tube and during anesthesia can help to diagnose endobronchial intubation.