Avoidance of endobronchial intubation

Endotracheal intubation is commonly performed to secure the airway in a variety of clinical settings, including prehospital and emergency room settings; the intensive care unit; and, most commonly, the operating room. Endobronchial intubation as a complication of endotracheal intubation can cause atelectasis and hypoxaemia, as well as potential hyperinflation and barotrauma of the intubated lung. Although several methods are currently available to identify oesophageal intubation, only chest radiography and bronchoscopy can reliably detect endobronchial intubation, and effective bedside techniques to detect this complication are needed. In the linked prospective randomised trial (doi:10.1136/bmj.c5943), Sitzwohl and colleagues describe a simple technique that can be used by any clinician performing endotracheal intubation to predict, and thus avoid, endobronchial intubation⇓.1

Accidental endobronchial intubation occurs in about 5% of patients in intensive care, 28% of those with a cardiac arrest,2 3 and 10% of out of hospital endotracheal intubations.4 In the Australian Incident …