A neonate having congenital diaphragmatic hernia developed respiratory distress. Breath sounds were decreased on the left side. After bag and mask ventilation, ET tube was put and the maximal cardiac impulse shifted to the right side. What should be the next step in management -

Ans. is 'b' i.e., Remove tube & reattempt intubation o Dont get confuse with answer of previous question. o There is difference between option 'a' of previous question and option 'a' of this question : ? Previous question - confirm the position of endotracheal tube. This question - confirm the position of ET tube by chest x-ray. o Best answer would have been, confirm the position of endotracheal tube. o But, chest x-ray cannot distinguish between tracheal and esophageal intubation and cannot confirm the position of the ET tube in trachea. Chest x-ray is done to confirm the correct length of tube (not the position). Method to confirm tracheal intubation 1. Tests which suggest tracheal placement (not confirmatory) Symmetrical Bilateral chest movements when reservoir bag is squeezed. Equal breath sounds over lung fields when reservoir bag is squeezed. Absence of gurgle over lung fields when reservoir bag is squeezed. Misting of the tube (water vapour deposition) during expiration. Feeling of correct lung compliance and refilling of bag during expiration. 2. Confirmatory tests Capnography --> Measures end tidal CO2 in expired gas. Esophageal detector device. o None of these method has been mentioned in the options of this question. o Amongst the given options, best course of action is to remove the tube and reattempt intubation : ? "If there is any doubt about tube placement the tube should be removed" --- Lee.