Efficacy of the transillumination method for appropriate tracheal tube placement in small children: a randomized controlled trial

Abstract

Study objective: To evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method.

Design: Prospective, randomized, controlled study.

Setting: Operating room, university hospital.

Patients: Eighty children <2 years old scheduled for elective surgery undergoing general anesthesia.

Interventions: Trachlight was used for the transillumination method. After intubation, patients were randomly assigned to 1 of 2 groups: (1) deliberate bronchial intubation with subsequent withdrawal of the TT to 2 cm above the carina (main-stem group) or (2) transmitted visual signal from a bright light at the TT tip on the skin at the suprasternal notch after inserting the Trachlight into the TT (transillumination group).

Measurements: The TT tip position was assessed by chest radiograph after the procedure. Appropriate TT placement was defined when the TT tip was located between the sternoclavicular junction and 1 cm above the carina.

Main results: Appropriate TT placement was found in 31 (80%) of 39 patients in the transillumination group and 26 (65%) of 40 in the main-stem group. The transillumination method had higher rate of appropriate TT placement than the main-stem method (P = .15; risk ratio, 1.22; 95% confidence interval, 0.93-1.61). Seven patients (18%) had proximal TT placement, and 1 (3%) had distal TT placement in the transillumination group. In the main-stem group, 7 patients (18%) had proximal TT placement, and 7 (18%) had distal TT placement.

Conclusions: The transillumination method was reliable for appropriate TT placement in small children <2 years old undergoing general anesthesia, although the transillumination method was not found to be better compared with the main-stem method.

Keywords: Child; General anesthesia; Intubation; Transillumination.