Introduction: Confirmation of proper endotracheal tube placement is one of the most important and lifesaving issues of tracheal intubation. The present study was aimed to evaluate the accuracy of tracheal ultrasonography by emergency residents in this regard.
Method: This was a prospective, cross sectional study for evaluating the diagnostic accuracy of ultrasonography in endotracheal tube placement confirmation compared to a combination of 4 clinical confirmation methods of chest and epigastric auscultation, direct laryngoscopy, aspiration of the tube, and pulse oximetry (as reference test).
Results: 150 patients with the mean age of 58.52 ± 1.73 years were included (56.6% male). Sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratio of tracheal ultrasonography in endotracheal tube confirmation were 96 (95% CI: 92-99), 88 (95% CI: 62-97), 98 (95% CI: 94-99), 78 (95% CI: 53-93), 64 (95% CI: 16-255), and 0.2 (95% CI: 0.1-0.6), respectively.
Conclusion: The present study showed that tracheal ultrasonography by trained emergency medicine residents had excellent sensitivity (>90%) and good specificity (80-90) for confirming endotracheal tube placement. Therefore, it seems that ultrasonography is a proper screening tool in determining endotracheal tube placement.
Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: Adult advanced cardiovascular life support 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 suppl 3):S729-S67.
Schwartz DE, Matthay MA, Cohen NH. Death and Other Complications of Emergency Airway Management in Critically Ill Adults A Prospective Investigation of 297 Tracheal Intubations. The Journal of the American Society of Anesthesiologists. 1995;82(2):367-76.
Mort TC. Unplanned tracheal extubation outside the operating room: a quality improvement audit of hemodynamic and tracheal airway complications associated with emergency tracheal reintubation. Anesthesia & Analgesia. 1998;86(6):1171-6.
Grmec Š. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive care medicine. 2002;28(6):701-4.
Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesthesia & Analgesia. 2004;99(2):607-13.
Roberts JR, Hedges JR. Roberts and Hedges’ clinical procedures in emergency medicine: Elsevier Health Sciences; 2013.
Foutch RG, Magelssen MD, MacMillan JG. The esophageal detector device: a rapid and accurate method for assessing tracheal versus esophageal intubation in a porcine model. Annals of emergency medicine. 1992;21(9):1073-6.
Garnett AR, Ornato JP, Gonzalez ER, Johnson EB. End-tidal carbon dioxide monitoring during cardiopulmonary resuscitation. Jama. 1987;257(4):512-5.
Ma G, Davis DP, Schmitt J, Vilke GM, Chan TC, Hayden SR. The sensitivity and specificity of transcricothyroid ultrasonography to confirm endotracheal tube placement in a cadaver model. The Journal of emergency medicine. 2007;32(4):405-7.
Chou H-C, Tseng W-P, Wang C-H, Ma MH-M, Wang H-P, Huang P-C, et al. Tracheal rapid ultrasound exam (TRUE) for confirming endotracheal tube placement during emergency intubation. Resuscitation. 2011;82(10):1279-84.
Werner SL, Smith CE, Goldstein JR, Jones RA, Cydulka RK. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Annals of emergency medicine. 2007;49(1):75-80.
Muslu B, Sert H, Kaya A, Demircioglu RI, Gözdemir M, Usta B, et al. Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients. Journal of Ultrasound in Medicine. 2011;30(5):671-6.
Sim S-S, Lien W-C, Chou H-C, Chong K-M, Liu S-H, Wang C-H, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation. Resuscitation. 2012;83(3):307-12.
Chou H-C, Chong K-M, Sim S-S, Ma MH-M, Liu S-H, Chen N-C, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84(12):1708-12.
Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (TRUST) for confirming correct endotracheal tube depth in children. Resuscitation. 2015;89:8-12.
Zadel S, Strnad M, Prosen G, Mekiš D. Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation. 2015;87:1-6.
Milling TJ, Jones M, Khan T, Tad-y D, Melniker LA, Bove J, et al. Transtracheal 2-d ultrasound for identification of esophageal intubation. The Journal of emergency medicine. 2007;32(4):409-14.
Quintela PA, Erroz IO, Matilla MM, Blanco SR, Zubillaga DM, Santos LR. Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation. Anales de Pediatría (English Edition). 2014;81(5):283-8.
Gottlieb M, Bailitz JM, Christian E, Russell FM, Ehrman RR, Khishfe B, et al. Accuracy of a novel ultrasound technique for confirmation of endotracheal intubation by expert and novice emergency physicians. Western Journal of Emergency Medicine. 2014;15(7):834.
Budhram G, Murman D, Lutfy L, Sullivan A. Sonographic Confirmation of Intubation Comparison of 3 Methods in a Pig Model. Journal of Ultrasound in Medicine. 2014;33(11):1925-9.
Sun J-T, Chou H-C, Sim S-S, Chong K-M, Ma MH-M, Wang H-P, et al. Ultrasonography for proper endotracheal tube placement confirmation in out-of-hospital cardiac arrest patients: two-center experience. Journal of Medical Ultrasound. 2014;22(2):83-7.
Chou EH, Dickman E, Tsou P-Y, Tessaro M, Tsai Y-M, Ma MH-M, et al. Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis. Resuscitation. 2015;90:97-103.
Das SK, Choupoo NS, Haldar R, Lahkar A. Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Canadian Journal of Anesthesia/Journal canadien d'anesthésie. 2015;62(4):413-23.
Pfeiffer P, Rudolph S, Børglum J, Isbye D. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement. Acta Anaesthesiologica Scandinavica. 2011;55(10):1190-5.