Bedside Ultrasound for Confirmation of Endotracheal Tube Placement in the Emergency Department

The Role of Bedside Ultrasound in Confirming Endotracheal Tube Placement in Patients Undergoing Endotracheal Intubation in the Emergency Department

This prospective observational study evaluated the role of bedside ultrasound in confirming endotracheal tube placement in adult patients who underwent endotracheal intubation in the emergency department. Correct placement of the endotracheal tube is critical because unrecognized incorrect placement may cause hypoxemia, hypoxic brain injury, or death.

In this study, bedside ultrasound was performed during or immediately after endotracheal intubation without interfering with the intubation procedure. Ultrasound findings were compared with capnographic end-tidal carbon dioxide measurement, which was used as the reference method for confirming tube placement. The main aim was to assess whether bedside ultrasound is a useful and reliable method for confirming endotracheal tube position in emergency department patients.

Study Overview

• Status: Completed
• Conditions: Endotracheal Intubation; Airway Management; Capnography; Endotracheal Tube Placement; Ultrasonographic

Detailed Description

This single-center, prospective observational diagnostic accuracy study was conducted in the Emergency Department of Antalya Training and Research Hospital. Adult patients who underwent endotracheal intubation in the emergency department after ethics committee approval were included.

Endotracheal intubation was performed as part of routine emergency care by the most senior emergency medicine resident or an experienced emergency physician. Bedside ultrasound assessment was performed during or immediately after intubation by trained emergency physicians without interrupting or delaying the intubation procedure. The ultrasound examination was performed from the suprasternal notch region to assess the position of the endotracheal tube.

The physicians who performed bedside ultrasound had at least two years of emergency medicine experience and had completed accredited ultrasound training. Before study data collection, they received additional theoretical and practical training focused on ultrasound confirmation of endotracheal tube placement.

Ultrasound findings were compared with capnometric end-tidal carbon dioxide measurement, which was used as the reference method for confirmation of endotracheal tube placement. Ultrasound images were stored in the hospital computer system and reviewed by two qualified, independent radiology specialists. Images or measurements with insufficient quality were excluded from analysis. Agreement between ultrasound assessments was evaluated statistically.

The study aimed to determine whether bedside ultrasound can be used as a rapid, reliable, and practical method for confirming endotracheal tube placement in emergency department patients.

• Study Type: Observational
• Enrollment (Actual): 70

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • konyaaltı
    • Antalya, konyaaltı, Turkey (Türkiye), 07100
      • University of Health Sciences, Antalya Training and Research Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

The study population consisted of adult patients aged 18 years or older who presented to the Emergency Department of Antalya Training and Research Hospital and underwent endotracheal intubation as part of routine emergency care. Patients were included after ethics committee approval if bedside ultrasound and capnometric end-tidal carbon dioxide assessment were performed for confirmation of endotracheal tube placement.

Description

Inclusion Criteria:

• Patients aged 18 years or older
• Patients who underwent endotracheal intubation in the emergency department as part of routine emergency care
• Patients in whom bedside ultrasound and capnometric end-tidal carbon dioxide assessment were performed for confirmation of endotracheal tube placement

Exclusion Criteria:

• Patients younger than 18 years of age
• Patients with missing or incomplete study data
• Patients with ultrasound images of insufficient quality for evaluation

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort

Patients Undergoing Endotracheal Intubation in the Emergency Department; Adult patients who underwent endotracheal intubation in the emergency department were included in this cohort. Endotracheal intubation was performed as part of routine emergency care. Bedside ultrasound was performed during or immediately after intubation by trained emergency physicians without interrupting the procedure. Ultrasound findings were compared with capnometric end-tidal carbon dioxide measurement, which was used as the reference method for confirming endotracheal tube placement.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Diagnostic Accuracy of Bedside Ultrasound for Confirmation of Endotracheal Tube Placement	The diagnostic accuracy of bedside ultrasound for confirming endotracheal tube placement will be evaluated by comparing ultrasound findings with capnometric end-tidal carbon dioxide measurement, which will be used as the reference method. Diagnostic performance will be assessed using sensitivity, specificity, positive predictive value, negative predictive value, overall accuracy, and agreement with the reference method.	During or immediately after endotracheal intubation, within a maximum of 20 seconds

Collaborators and Investigators

• Sponsor: Antalya Health Sciences University
• Investigators: Principal Investigator: MURAT DUYAN, ASSOCIATE PROFESSOR, University of Health Sciences, Antalya Training and Research Hospital; Study Director: HALIT EKICI, MEDICAL DOCTOR, University of Health Sciences, Antalya Training and Research Hospital; Study Director: CEMIL KAVALCI, PROFESSOR, University of Health Sciences, Antalya Training and Research Hospital; Study Director: ENGIN DENIZ ARSLAN, ASSOCIATE PROFESSOR, University of Health Sciences, Antalya Training and Research Hospital; Study Director: FEVZI YILMAZ, University of Health Sciences, Antalya Training and Research Hospital

Publications and helpful links

General Publications

• Long B, Koyfman A, Gottlieb M. Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement. Acad Emerg Med. 2019 Sep;26(9):1096-1098. doi: 10.1111/acem.13773. Epub 2019 May 23. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): January 10, 2025
• Primary Completion (Actual): June 10, 2026
• Study Completion (Actual): June 10, 2026

Study Registration Dates

• First Submitted: June 20, 2026
• First Submitted That Met QC Criteria: June 20, 2026
• First Posted (Actual): June 25, 2026

Study Record Updates

• Last Update Posted (Actual): June 25, 2026
• Last Update Submitted That Met QC Criteria: June 20, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Point-of-care ultrasound; Endotracheal tube placement; Capnography; Bedside ultrasound; Endotracheal tube confirmation
• Other Study ID Numbers: 2025-019

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared publicly because the study includes clinical data from emergency department patients and there may be confidentiality and institutional restrictions. De-identified aggregate results will be reported in scientific publications.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No