A New Simple, Tactile, Laryngeal Manoeuver, to Confirm Correct Placement of an Endotracheal Tube

Background: Confirmation of correct placement of the endotracheal tube is vitally important when performing endotracheal intubation. Most of the tests used to confirm the correct location of the tracheal tube have their own inherent drawbacks. Herewith, we introduce a new method which we hypothesize possesses high reliability when securing the airway. Methods: One hundred and seventy eight patients, ASA 1, non-pregnant and without head and neck abnormality were studied. Anesthesia technique and monitoring were the same for all the patients. The cricothyroid complex was manipulated using a digital maneuver both after esophageal and endotracheal intubation, for all the patients and any paradoxical movement of the endotracheal tube was recorded during the maneuver to confirm either endotracheal intubation or esophageal intubation. The test parameters included true positive, false positive, true negative, false negative, sensitivity, specificity and accuracy for paradoxical motion, based on the tracheal tube position. The relationship between the extent of tracheal tube movement and the position of tracheal tube was analyzed and a p value < 0.05 was considered to be statistically significant. Results: The mean age of the patients was 40.5 ± 14.6. The paradoxical motion test was 93.3% sensitive, and 77.5% specific, in the diagnosis of correct anatomical placement of the tracheal tube. One hundred and sixty six (93.2%) patients were diagnosed as true positive. Positive and negative predictive value of paradoxical motion was 80.6% and 92.0%, respectively, with an accuracy rate of 85.4%. Conclusions: Paradoxical movement of the endotracheal tube after digital cricothyroid complex movement, is an appropriate and a diagnostic test to confirm the insertion of the tube in the trachea, and is an additional important test to ensure correct placement of the endotracheal tube.