Undetected esophageal intubation is a serious problem in intensive care patients. In patients in whom the vocal cords cannot be visualized, an esophageal intubation may be difficult to recognize. Capnography is one of the most reliable of the methods used to detect esophageal intubation, and it has been suggested that PetCO2 should be used routinely to verify correct endotracheal tube placement. The limitations on the use of PetCO2 to detect esophageal intubation are the presence of CO2 or a carbonated beverage in the stomach and the presence of low pulmonary perfusion or a cardiac arrest ( Hess 1990).
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