A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians

Abstract

Objectives Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real‐time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. Methods We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end‐tidal carbon dioxide detection results, performed real‐time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. Results Seventy‐two patients were enrolled in the study. Sixty‐eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false‐negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%–99.9%) and specificity of 75.0% (95% confidence interval, 19.4%–99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. Conclusions A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position.

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

“…Moreover, Lahham et al [19] performed real-time transverse tracheal sonography during intubation to evaluate correct ETT placement and detected correct tracheal placement in 94.4% of patients, while 5.6% of intubations were interpreted as esophageal, and concluded that US conferred sensitivity and specificity rates of 98.5% and 75%, respectively.…”

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

“…157 The ASA Closed Claims Project shows that bronchial intubations account for 4% of respiratory claims in children compared with 2% in adults. 158 Point-of-care LUS correctly identifies endobronchial intubation in 95%-100% of children. 153 159 160 Diagnosis of an interstitial syndrome and pneumothorax is similar to adult data.…”

Seeing Is Believing: Ultrasound in Pediatric Procedural Performance

“…Adult and pediatric literature reveal a sensitivity and specificity of 98.5% to 100% and 75% to 100%, respectively, for this method. [84][85][86][87] Obesity, abnormal airways, and short necks may limit visibility. This technique has also been described in extremely preterm infants.…”