Confirmation of tracheal tube placement with a flexible bronchoscope when the capnograph trace is absent due to bronchospasm

2025/07/01 by Jordan Robinson, Sarah Goellner, Peter W. Hart · 1 voice
Medicine · #Airway Management and Intubation Techniques #Anesthesia and Sedative Agents #Restraint-Related Deaths

paper · doi:10.1002/anr3.70025

openalex publication_date 2025/07/01 · openalex created_date 2025/10/10 · openalex updated_date 2026/05/21

Abstract

Detection of sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation in current practice. However, this may be impossible in rare clinical situations. International guidelines include flexible bronchoscopy as an alternative method of confirming tracheal intubation when capnography is inconclusive and tube removal is considered dangerous. We present the case of a patient with severe bronchospasm who aspirated gastric contents at induction of anaesthesia for ventilatory support for respiratory failure. Following apparent tracheal intubation, ventilation appeared impossible and no capnography trace could be obtained. Tracheal intubation was confirmed using flexible bronchoscopy, and the patient subsequently recovered following a period of extracorporeal membrane oxygenation. This case illustrates the value of flexible bronchoscopy in the unusual situation when ventilation is so compromised that capnography is unobtainable.

Citations

• Recommendations for standards of monitoring during anaesthesia and recovery 2021
• Preventing unrecognised oesophageal intubation: a consensus guideline from the Project for Universal Management of Airways and international airway societies*

Discussions

• Sustained, exhaled carbon dioxide by waveform capnography is an essential component of tracheal intubation. But what if there is bronchospasm? Tracheal intubation can be confirmed using flexible br [bsky, 2 points, 1 comments]

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