Original contribution Prompt correction of endotracheal tube positioning after intubation prevents further inappropriate positions ☆,☆☆,★ Nugzar Rigini MD (Attending) a , Mona Boaz PhD (Chief Epidemiologist and Statistician) b , Tiberiu Ezri MD (Associate Professor and Head) a,d, ⁎ , Shmuel Evron MD (Associate Professor) a,d , Dimitry Trigub MD (Attending) a , Simon Jackobashvilli MD (Attending and Deputy head) a , Alexander Izakson MD (Attending and head) c a Department of Anesthesia, Wolfson Medical Center (affiliated with Tel Aviv Medical School, Tel Aviv, Israel), Holon 58100, Israel b Department of Epidemiology, Wolfson Medical Center (affiliated with Tel Aviv Medical School, Tel Aviv, Israel), Holon 58100, Israel c Department of Anesthesia, Rebecca Sieff Medical Center, Tzfat (Safed) 13100, Israel d Outcomes Research Consortium, The Cleveland Clinic, Cleveland, OH 44195, USA Received 6 March 2010; revised 29 September 2010; accepted 9 November 2010 Keywords: Chest auscultation; Endotracheal tube; Inappropriate positioning; Fiberoptic bronchoscopy Abstract Study Objective: To determine whether the timely correction of endotracheal tube (ETT) positioning prevents further inappropriate positions. Design: Prospective crossover study. Setting: University-affiliated hospital. Patients: 44 adult, ASA physical status 1, 2, and 3 patients undergoing open or laparoscopic abdominal procedures. Interventions: ETT positioning was verified by both auscultation and fiberoptic bronchoscopy (FOB), after intubation, and before extubation. In laparoscopic procedures, two additional measurements were performed: after maximal abdominal gas insufflation and with head-down position. An ETT in the bronchus or at the carina was considered an inappropriate placement. An ETT ≤ one cm from the carina was considered a critical placement. Measurements: The frequency of inappropriate and critical ETT positioning with both auscultation and FOB and the number of ETTs that remained in an incorrect position despite repositioning. Main Results: FOB detected 5 inappropriately positioned ETTs, 4 of which were also detected by chest auscultation (P = 0.99). Critical positioning was detected by FOB in 6 patients, three of which were also detected by auscultation (P = 0.24). There were 15 other qout-of-desired range” positions (out of the ☆ Pressented in part at the annual meeting of the American Society of Anesthesiologists, New Orleans, LA, Oct. 17-21, 2009. ☆☆ Support: Department funding only. ★ The authors have no conflicts of interest to declare. ⁎ Corresponding author. Department of Anesthesia, Wolfson Medical Center, Holon 58100, Israel. Tel.: +972 3 502 8229; fax: +972 3 502 8218. E-mail addresses: tezri@netvision.net.il, ezri@wolfson.health.gov.il (T. Ezri). 0952-8180/$ – see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.jclinane.2010.11.002 Journal of Clinical Anesthesia (2011) 23, 367–371