Can pediatric anesthesiologists detect an occluded tracheal in neonates?

To determine whether pediatric anesthesiologists can reliably detect occlud ed tracheal tubes, 18 pediatric anesthesiologists who were blindfolded and fitted with earplugs manually ventilated the lungs of 16 neonates. Consent was obtained from the parents of the neonates. Ail auditory signals from th e monitors were silenced. Six conditions were studied (for 3 min each) in r andom order: three models of Ayre's t-piece with the Jackson Rees modificat ion and two fresh gas flows (FGF) (2 and 6 L/min). During each condition, t he tracheal tube was clamped at fi-cre predetermined but randomized times. The volume/pressure relationships of the three t-piece models were determin ed. Tube occlusions were detected more frequently at a low FGF (82%) than a t a high FGF (64%) (P < 0.001). Experienced anesthesiologists (>8 yr experi ence) detected occlusions (83%) more frequently than less experienced (<2 y r experience) anesthesiologists (63%) (P < 0.027). There was no interaction between FGF and experience. The type of circuit did not affect the detecti on rate. We conclude that during isolated hand ventilation with the t-piece , pediatric anesthesiologists can detect > 80% of occluded tubes provided t hey use a low FGF or have >8 yr experience, but only 60% of occluded tubes at high FGF or if they have <2 yr experience.