USE OF THE ESOPHAGEAL DETECTOR DEVICE IN A NEWBORN-PIGLET MODEL

Study objective: To determine the accuracy of the esophageal detector device (EDD) in predicting correct endotracheal tube (ETT) placement i n a newborn-piglet model. Methods: We used an EDD, comprising a 5-, 10 - or 20-mL syringe attached to 4-mm tubing fitted to a 15-mm ETT adapt er, to aspirate gas from cuffed or uncuffed ETTs placed in the trachea or esophagus of each newborn piglet. During aspiration, we noted any resistance encountered while pulling back the plunger of the syringe a nd recorded the total volume of gas aspirated into the syringe. A posi tive test, signifying tracheal ETT placement, was defined as the abili ty to freely aspirate gas without resistance and the aspiration of eno ugh gas to fill the entire volume of the syringe. A negative test, sig nifying esophageal ETT placement, was defined: as resistance encounter ed during the aspiration of gas into the syringe and rebound of the sy ringe plunger, leading to aspiration of a volume of gas less than the total volume of the syringe. Results: We conducted 444 trials (222 for uncuffed Errs, 222 for cuffed Errs). ETT size ranged from 3.0 to 4.5 mm. For cuffed ETTs, the 5-mL syringe had a sensitivity of 100% and a specificity of 5%, the 10-mL syringe had a sensitivity of 95% and a sp ecificity of 16%, and the 20-mL syringe had a sensitivity of 86% and a specificity of 97%. For uncuffed Errs, the 5-mL syringe had a sensiti vity of 100% and a specificity of 5%, the 10-ml syringe had a sensitiv ity of 97% and a specificity of 24%, and the 20-mL syringe had a sensi tivity of 81% and a specificity of 100%. Conclusion: No syringe had 10 0% sensitivity and specificity in correctly predicting ETT placement. The 20-mL syringe had the highest combination of sensitivity and speci ficity. Further studies are warranted to determine whether the EDD usi ng a 20-mL syringe would aid in the prediction of correct ETT placemen t in the pediatric-population.