Ultrasound confirmation of endotracheal tube placement

Abstract

Introduction Endotracheal intubation is an important technique in airway management. Although, little experience is present in the use of ultrasound in endotracheal intubation, studies suggest that it is reliable and fast as other usual methods and is a simple, feasible, portable, and noninvasive tool. Aim To assess the usefulness of ultrasonography compared with capnography and chest radiography in confirmation of correct endotracheal tube position in ICU patients. Patients and methods Fifty patients in need for intubation were included in this study. All patients were subjected immediately after intubation to the following to confirm correct endotracheal intubation: clinical evaluation, neck ultrasound, chest ultrasound, and chest radiographs. All methods were compared with capnography, the gold standard method for confirmation. Results Successful endotracheal intubation was confirmed by the presence of three successive waves in the capnography. This was achieved in 48 (96%) of cases (endotracheal tube), and in two (4%) cases, the tube was falsely placed in the esophagus. Direct localization of intubation by neck ultrasound had 97.7% sensitivity and 100% specificity to confirm correct intubation. On the contrary, indirect localization of the tube by chest ultrasound had 93.7% sensitivity and 100% specificity. Although localization of the tube by chest radiography has 97.8% sensitivity, it took longer time to be done in such critical casas (29236.44 ± 768.27 s). Clinical evidence of intubation had 95.8% sensitivity and 100% specificity. Conclusion Ultrasonography is a feasible, fast, and cost-effective method for the confirmation of the correct endotracheal tube placement.

Keywords

• endotracheal tube
• capnography
• chest ultrasonography
• ultrasonography