Efficacy of the self-inflating bulb in detecting esophageal intubation. Does the presence of a nasogastric tube or cuff deflation make a difference?

BACKGROUND: The principle underlying the use of the self-inflating bulb in differentiating esophageal from tracheal intubation is that the trachea is held open by rigid cartilaginous rings, whereas the esophagus collapses when a negative pressure is applied to its lumen. This investigation was designed to test the efficacy of the bulb in detecting esophageal intubation in the presence of a nasogastric tube and after tracheal tube cuff deflation. METHODS: In anesthetized patients, the trachea and esophagus were intubated with identical tubes. The efficacy of the bulb was tested after a nasogastric tube was placed (group 1, n = 70) and after cuff deflation (group 2, n = 60) by a second anesthesiologist. RESULTS: In patients with nasogastric tubes (group 1), the anesthesiologists reported no reinflation of the compressed bulbs connected to tubes placed in the esophagus and immediate reinflation when connected to tracheally placed tubes in every case. In group 2, the determination of tube placement was correct in every case after cuff deflation. Mean (+/- SEM) negative pressures generated when compressed bulbs were connected to esophageally placed tubes were 57.8 +/- 0.48 mmHg (group 1) and 55.3 +/- 0.52 mmHg (group 2) and remained unchanged after the introduction of nasogastric tubes or after cuff deflation. CONCLUSIONS: These results confirm that a nasogastric tube or cuff deflation does not interfere with the reliability of the self-inflating bulb in detecting esophageal intubation and thus does not contribute to false positive results. Confirmation of tracheal tube placement by this simple method makes it ideal for use with other recognized methods both in and outside the operating rooms and enables physicians and emergency personnel to proceed with other resuscitative measures.