Do not use The Presence of End-Tidal CO2 to Rule Out Esophageal Intubation
Patricia M. Veloso MD
You are called to emergently intubate an obese woman for increasing respiratory distress who is four hours postoperative from an uneventful nephrectomy. She was successfully extubated in the operating room and initially on admission to the intensive care unit (ICU) looked like she would be a straightforward one-night ICU stay. On your arrival to the bedside, the medical student is attempting to mask-ventilate her. You ready your laryngoscope and the endotracheal tube and proceed to secure the airway. You are confident that you intubated the trachea although her body habitus made the intubation challenging. The respiratory therapist hooks up the portable end-tidal CO2 monitor, gives the patient a breath, and tells you “good job” because the portable endtidal CO2 monitor detects the presence of CO2. The nurse also tells you he hears bilateral breath sounds. Are you satisfied with this assessment and ready to have the respiratory therapist tape the endotracheal tube?
No! You should not be satisfied with this assessment of the placement of the endotracheal tube. Detection of CO2 in one breath by the CO2 monitor is not sufficient to ensure that the endotracheal tube is indeed in the trachea.