Five studies involving 9,931 tube placements (range 740 to 4,190) were included. Four studies were described as retrospective RCTs and one had a case-control design. Studies were conducted between 1986-1987 and 2005. The authors described the quality of the evidence as relatively strong.
There were 187 tube misplacements in the pulmonary tree across all studies (1.9%). Of these, 35 were associated with pneumothorax, leading to at least five patient deaths. Overall, 60% of misplacements occurred in mechanically ventilated patients. Rates of repeat misplacement (based on three studies) ranged from 13% to 32%. Eight out of 35 patients with repeat misplacements died.
Two of the included studies reported interventions to reduce complications associated with tube placement. In one study, the formation of a specialist team was associated with a reduction in procedure-related pneumothorax.