Screening Performance Characteristics of Ultrasonography in Confirmation of Endotracheal Intubation; A Systematic Review and Meta-analysis
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e68
https://doi.org/10.22037/aaem.v9i1.1360
Abstract
Introduction: Recent studies have suggested that point-of-care ultrasonography can be used for confirming the placement of endotracheal tube. This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of ultrasonography for confirming endotracheal tube placement.
Methods: In this meta-analysis, systematic search of the previous published papers investigating the diagnostic accuracy of ultrasonography for confirmation of endotracheal tube placement was performed. Seven electronic databases, including PubMed, Scopus, Google Scholar, EBSCO, EMBASE, Web of Science, and Cochrane Database were searched up to July 2021, for all relevant articles published in English on this topic. Meta-DiSc version 1.4 software was used for statistical analysis.
Results: The estimated pooled sensitivity and specificity of ultrasonography for confirmation of endotracheal tube location were 0.98 (95% CI: 0.98–0.99) and 0.94 (95% CI 0.91–0.96), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 5.94 (95% CI 4.41–7.98) and 0.03 (95% CI: 0.02-0.04), respectively. The diagnostic odds ratio of ultrasonography was 281.47 and the area under hierarchical summary receiver operating characteristic (HSROC) revealed an appropriate accuracy of 0.98.
Conclusion: Ultrasonography has high diagnostic accuracy and can be used as a promising tool for confirmation of endotracheal tube placement, especially in critically ill patients or when capnography is not available, or its result is equivocal.
- Airway management
- intubation
- meta-analysis
- sensitivity and specificity
- ultrasonography
How to Cite
References
Chen W, Chen J, Wang H, Chen Y. Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit. Journal of International Medical Research. 2020;48(4):0300060519894771.
Endlich Y, Lee J, Culwick MD. Difficult and failed intubation in the first 4000 incidents reported on webAIRS. Anaesthesia and intensive care. 2020;48(6):477-87.
Chowdhury AR, Punj J, Pandey R, Darlong V, Sinha R, Bhoi D. Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents-A prospective controlled clinical trial. Saudi journal of anaesthesia. 2020;14(1):15.
Sharma D, Tabatabaii SA, Farahbakhsh N. Role of ultrasound in confirmation of endotracheal tube in neonates: a review. The Journal of Maternal-Fetal & Neonatal Medicine. 2019;32(8):1359-67.
Abhishek C, Munta K, Rao SM, Chandrasekhar C. End-tidal capnography and upper airway ultrasonography in the rapid confirmation of endotracheal tube placement in patients requiring intubation for general anaesthesia. Indian journal of anaesthesia. 2017;61(6):486.
Mitra A, Gave A, Coolahan K, Nguyen T. Confirmation of endotracheal tube placement using disposable fiberoptic bronchoscopy in the emergent setting. World journal of emergency medicine. 2019;10(4):210.
Silvestri S, Ladde JG, Brown JF, Roa JV, Hunter C, Ralls GA, et al. Endotracheal tube placement confirmation: 100% sensitivity and specificity with sustained four-phase capnographic waveforms in a cadaveric experimental model. Resuscitation. 2017;115:192-8.
Masoumi B, Azizkhani R, Emam GH, Asgarzadeh M, Kharazi BZ. Predictive value of tracheal rapid ultrasound exam performed in the emergency department for verification of tracheal intubation. Open access Macedonian journal of medical sciences. 2017;5(5):618.
Lahham S, Baydoun J, Bailey J, Sandoval S, Wilson SP, Fox JC, et al. A prospective evaluation of transverse tracheal sonography during emergent intubation by emergency medicine resident physicians. Journal of ultrasound in medicine. 2017;36(10):2079-85.
Karacabey S, Sanrı E, Gencer EG, Guneysel O. Tracheal ultrasonography and ultrasonographic lung sliding for confirming endotracheal tube placement: Speed and Reliability. The American journal of emergency medicine. 2016;34(6):953-6.
Callaway CW, Soar J, Aibiki M, Böttiger BW, Brooks SC, Deakin CD, et al. Part 4: advanced life support: 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation. 2015;132(16_suppl_1):S84-S145.
Long B, Koyfman A, Vivirito MA. Capnography in the emergency department: a review of uses, waveforms, and limitations. The Journal of emergency medicine. 2017;53(6):829-42.
Adhikari S, Farrell I, Stolz U. 46 How Accurate Is Ultrasonography in Confirming Endotracheal Tube Placement? A Meta-analysis. Annals of Emergency Medicine. 2012;60(4):S18.
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.
Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis. Annals of emergency medicine. 2018;72(6):627-36.
Men XQ, Yan XX. Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients. Journal of Ultrasound in Medicine. 2020;39(3):509-13.
Patil V, Bhosale S, Kulkarni A, Prabu N, Bhagat V, Chaudhary H, et al. Utility of ultrasound of upper airway for confirmation of endotracheal intubation and confirmation of the endotracheal tube position in the intensive care unit patients. J Emerg Crit Care Med. 2019;3:15-.
Afzalimoghaddam M, Basiri K, Dvarani S, Bagheri F, Karimialavijeh E. The effectiveness of a short training course for emergency medicine residents to confirm tracheal tube placement by ultrasound. Crit Care Shock. 2019;22:1-8.
Zamani M, Esfahani MN, Joumaa I, Heydari F. Accuracy of real-time intratracheal bedside ultrasonography and waveform capnography for confirmation of intubation in multiple trauma patients. Advanced biomedical research. 2018;7.
Kad N, Sikarwar A, Kumar V, Kumari D. A study to confirm the position of endotracheal tube using ultrasonography and standard auscultation method. Int J Contemp Med Res. 2018;5:L12-L6.
Kabil AE, Ewis AM, Al-Ashkar AM, Abdelatif MA, Nour MO. Real-time tracheal ultrasonography for confirming endotracheal tube placement. Egyptian Journal of Bronchology. 2018;12(3):323-8.
Deniz S, INANGIL G, Temircan S, Bakal Ö, Sen H, Özkan S. Validation of tracheal intubation of wire-reinforced endotracheal tube with ultrasonography. Signa vitae: journal for intesive care and emergency medicine. 2018;14(2):20-3.
Arya R, Schrift D, Choe C, Al‐Jaghbeer M. Real‐time tracheal ultrasound for the confirmation of endotracheal intubations in the intensive care unit: an observational study. Journal of Ultrasound in Medicine. 2019;38(2):491-7.
Arafa S, Abouzkry A, Mohamady A. Accuracy of bedside upper airway ultrasonography vs. standard auscultation for assuring the location of endotracheal tube after tracheal intubation: comparative study controlled by quantitative waveform capnography. J Anesth Clin Res. 2017;9.
Moghadam HZ, Sharifi MD, Rajabi H, Bazaz MM, Alamdaran A, Jafari N, et al. Screening characteristics of bedside ultrasonography in confirming endotracheal tube placement; a diagnostic accuracy study. Emergency. 2017;5(1).
Yang Y, Yue Y, Zhang D. The sensitivity and specificity of ultrasonic localization of endotracheal intubation. Int J Clin Exp Med. 2017;10(7):10143-51.
Thomas VK, Paul C, Rajeev PC, Palatty BU. Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine. 2017;21(5):257.
Rahmani F, Parsian Z, Shahsavarinia K, Pouraghaei M, Negargar S, Esfanjani RM, et al. Diagnostic value of sonography for confirmation of endotracheal intubation in the emergency department. Anesthesiology and pain medicine. 2017;7(6).
Rahul Khosla CK, Ahmad Alwassia. Using Ultrasound to Confirm Endotracheal Tube Position in the Intensive Care Unit. Journal of Anesthesia & Intensive Care Medicine. 2016;1(2).
Abbasi S, Farsi D, Zare MA, Hajimohammadi M, Rezai M, Hafezimoghadam P. Direct ultrasound methods: a confirmatory technique for proper endotracheal intubation in the emergency department. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2015;22(1):10-6.
Sun J-T, Sim S-S, Chou H-C, Chong K-M, Ma MH-M, Lien W-C. Ultrasonography for proper endotracheal tube placement confirmation in out-of-hospital cardiac arrest patients: two-center experience. Critical Ultrasound Journal. 2014;6(S1).
Hoffmann B, Gullett JP, Hill HF, Fuller D, Westergaard MC, Hosek WT, et al. Bedside ultrasound of the neck confirms endotracheal tube position in emergency intubations. Ultraschall in der Medizin (Stuttgart, Germany : 1980). 2014;35(5):451-8.
Sağlam C, Unlüer EE, Karagöz A. Confirmation of endotracheal tube position during resuscitation by bedside ultrasonography. The American journal of emergency medicine. 2013;31(1):248-50.
Hosseini JS, Talebian MT, Ghafari MH, Eslami V. Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view. International journal of critical illness and injury science. 2013;3(2):113-7.
Chou HC, Chong KM, Sim SS, Ma MH, Liu SH, Chen NC, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84(12):1708-12.
Adi O, Chuan TW, Rishya M. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation. Crit Ultrasound J. 2013;5(1):7.
Noh JK, Cho YS. The comparison of airway ultrasonography and continuous waveform capnography to confirm endotracheal tube placement in cardiac arrest patients: prospective observational study. Crit Ultrasound J. 2012;4(Suppl 1):A6.
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 : official journal of the American Institute of Ultrasound in Medicine. 2011;30(5):671-6.
Chou HC, Tseng WP, Wang CH, Ma MH, Wang HP, Huang PC, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation. 2011;82(10):1279-84.
Park SC, Ryu JH, Yeom SR, Jeong JW, Cho SJ. Confirmation of endotracheal intubation by combined ultrasonographic methods in the Emergency Department. Emergency medicine Australasia : EMA. 2009;21(4):293-7.
Werner SL, Smith CE, Goldstein JR, Jones RA, Cydulka RK. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med. 2007;49(1):75-80.
Milling TJ, Jones M, Khan T, Tad-y D, Melniker LA, Bove J, et al. Transtracheal 2-d ultrasound for identification of esophageal intubation. J Emerg Med. 2007;32(4):409-14.
- Abstract Viewed: 2449 times
- PDF Downloaded: 1174 times