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Colourimetric CO2 detector compared with capnography for confirming ET tube placement
  1. K Hogg, Clinical Research Fellow,
  2. S Teece, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin.mackway-jones{at}man.ac.uk

    Abstract

    A short cut review was carried out to establish whether colourimetric carbon dioxide detectors are as reliable as capnometry at verifying tracheal placement of endotracheal tubes after emergency intubation. A total of 69 papers were found using the reported search, of which four presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by K Hogg,Clinical Research FellowChecked by S Teece, Clinical Research Fellow

    Clinical scenario

    A 30 year old man is brought to the emergency department with a Glasgow Coma Scale score of 8 after falling down stone steps while drunk. Although he has not vomited, you are concerned that he cannot protect his airway. You decide to do a rapid sequence induction. As you organise and check your equipment, you ask the nurse to bring the departmental capnograph to the bedside. She tells you that it is still in ITU where it was left after transferring the last intubated patient. She does, however, suggest you use a disposable colourimetric CO2 detector found in the paediatric arrest trolley. You wonder whether you should wait five minutes while the capnograph is brought from ITU, or whether the colourimetric indicator will be just as accurate?

    Three part question

    In an [emergency intubation] is [a colourimetric carbon dioxide detector as reliable as capnography] at [verifying endotracheal tube placement]?

    Search strategy

    Medline 1966–02/03 using the OVID interface. [(exp Carbon Dioxide OR end-tidal.mp OR exp Capnography OR carbon dioxide.mp OR capnograph$.mp) AND (colorimetric.mp OR exp Colorimetry OR colourimetric.mp)] LIMIT to human AND English language.

    Search outcome

    Altogether 69 papers were found of which four were relevant to the question. Details of these papers are shown in table 3.

    Table 3

    Comment(s)

    There have been no studies investigating the use of these devices exclusively within the emergency department.

    Clinical bottom line

    The colourimetric CO2 detector is as accurate as IR capnography at detecting tracheal intubation, but is potentially less accurate at detecting oesophageal intubation.

    Report by K Hogg,Clinical Research FellowChecked by S Teece, Clinical Research Fellow

    References

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