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

•Two methods for appropriate tracheal tube placement were compared in small children.•The probability of appropriate TT placement was 80% in transillumination method.•The probability of appropriate TT placement was 65% in main-stem method.•The reliability of 2 methods was almost the same for appropriate TT placement.

Study ObjectiveTo evaluate whether the transillumination method increased the probability of appropriate tracheal tube (TT) placement compared with the main-stem method.DesignProspective, randomized, controlled study.SettingOperating room, university hospital.PatientsEighty children < 2 years old scheduled for elective surgery undergoing general anesthesia.InterventionsTrachlight 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).MeasurementsThe 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 ResultsAppropriate 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.ConclusionsThe 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.