Confirmation of placement of endotracheal tube - A comparative observational pilot study of three ultrasound methods

Ashok K Sethi, Rashmi Salhotra, Monika Chandra, Medha Mohta, Shuchi Bhatt, Choro A Kayina, Ashok K Sethi, Rashmi Salhotra, Monika Chandra, Medha Mohta, Shuchi Bhatt, Choro A Kayina

Abstract

Background and aims: Confirmation of endotracheal tube (ETT) position is necessary to ensure proper ventilation. The present study was conducted with the aim to compare the efficacy of three ultrasonographic (USG) techniques in terms of time taken for confirmation of ETT position. The time taken by each USG technique was also compared with that for auscultation and capnography. The ability of the three USG techniques to identify tracheal placement of ETT was evaluated in all patients.

Material and methods: Ninety adult American Society of Anesthesiologists (ASA) I/II patients requiring general anaesthesia with tracheal intubation were randomised into three groups (n = 30 each) depending upon the initial USG transducer position used to confirm tracheal placement of ETT: group T (tracheal), group P (pleural) and group D (diaphragm). The time taken for confirmation of tracheal placement of ETT by USG, auscultation and capnography was recorded for each of the groups. Subsequently, USG confirmation of ETT placement was performed with the other two USG techniques in all patients.

Results: The time taken for USG in group T was significantly less (3.8 ± 0.9 s) compared to group P (12.1 ± 1.6 s) and group D (13.8 ± 1.7 s); P < 0.001. USG was significantly faster than both auscultation and capnography in group T (P < 0.001), whereas in group P and group D, USG took longer time compared to auscultation (P = 0.014 and P < 0.001, respectively) but lesser time than capnography (P < 0.001 in both groups).

Conclusion: USG is a rapid technique for identification of ETT placement. All the three USG techniques are reliable in identifying the tracheal placement of ETT.

Keywords: Auscultation; capnography; tracheal intubation; ultrasonography.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT flow diagram
Figure 2
Figure 2
Ultrasonographic view of trachea. (a) Longitudinal orientation of transducer. (b) Transverse orientation of transducer
Figure 3
Figure 3
View of the visceral-parietal pleural interface with the transducer on the mid-clavicular line
Figure 4
Figure 4
Domes of the diaphragm as visualised from the sub-xiphoid window. (a) Left dome of diaphragm. (b) Right dome of diaphragm

References

    1. Al-Qahtani AS, Messahel FM, Ouda WOA. Inadvertent endobronchial intubation: A sentinel event. Saudi J Anaesth. 2012;6:259–62.
    1. Drescher MJ, Conard FU, Schamban NE. Identification and description of esophageal intubation using ultrasound. Acad Emerg Med. 2000;7:722–5.
    1. 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;32:409–14.
    1. Hosseini JS, Talebian MT, Ghafari MH, Eslami V. Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view. Int J Crit Illn Inj Sci. 2013;3:113–7.
    1. 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;49:75–80.
    1. Chou H-C, Tseng W-P, Wang C-H, Ma MH-M, Wang H-P, Huang P-C, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation. 2011;82:1279–84.
    1. Grmec S. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med. 2002;28:701–4.
    1. Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med. 2001;20:223–9.
    1. Weaver B, Lyon M, Blaivas M. Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad Emerg Med. 2006;13:239–44.
    1. Chun R, Kirkpatrick AW, Sirois M, Sargasyn AE, Melton S, Hamilton DR, et al. Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement. Prehosp Disaster Med. 2004;19:366–9.
    1. Pfeiffer P, Rudolph SS, Borglum J, Isbye DL. Temporal comparison of ultrasound vs. auscultation and capnography in verification of endotracheal tube placement. Acta Anaesthesiol Scand. 2011;55:1190–5.
    1. Breitkreutz R, Seibel A, Zechner PM. Ultrasound-guided evaluation of lung sliding for widespread use? Resuscitation. 2012;83:273–4.
    1. 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;83:307–12.
    1. Hsieh K-S, Lee C-L, Lin C-C, Huang T-C, Weng K-P, Lu W-H. Secondary confirmation of endotracheal tube position by ultrasound image. Crit Care Med. 2004;32:S374–7.
    1. Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics. 2009;123:e1039–44.
    1. Thomas VK, Paul C, Rajeev PC, Palatty BU. Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting. Indian J Crit Care Med. 2017;21:257–61.
    1. 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. J Utrasound Med. 2011;30:671–6.
    1. Marciniak B, Fayoux P, Hébrard A, Krivosic-Horber R, Engelhardt T, Bissonnette B. Airway management in children: Ultrasonography assessment of tracheal intubation in real time? Anesth Analg. 2009;108:461–5.
    1. Brunner JX, Westenskow DR. How the rise time of carbon dioxide analysers influence the accuracy of carbon dioxide measurements. Br J Anaesth. 1988;61:628–38.
    1. 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. J Emerg Med. 2007;32:405–7.

Source: PubMed

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