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 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