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

Abstract

Objectives: To estimate the accuracy and rapidity of bed-side upper airway ultrasonography (UA-US) versus standard auscultation (SA) for confirmation of endotracheal tube (ETT) position. Patients and methods:107 patients underwent tracheal intubation for maintenance of general anesthesia. Position of ETT was confirmed by chest auscultation for the presence of breath sounds on both sides, and by UA-US using 9-12 MHz linear US transducer that was placed transversely on the neck anteriorly and superior to the suprasternal notch to visualize the ETT in the tracheal transverse and longitudinal views. The data obtained were compared to findings on using waveform capnography (WC). Time to define ETT position was determined. Study outcomes included determination of ETT position; tracheal or esophageal, accuracy of diagnosis and time taken till confirming the diagnosis. Results:With comparison to WC findings, UA-US revealed sensitivity, specificity and accuracy rates of 97%, 71.4% and 95.3% while that for SA were 93.6%, 53.9% and 88.8%, respectively with significantly higher specificity and accuracy rates for UA-WC versus SA. Time required for confirmation of ETT position was significantly shorter with WC (9.16 ± 0.69 sec.) compared to SA and UA-US with significant difference in favor of UA-US (11.14 ± 1.3 vs. 13.5 ± 2.15 sec). Conclusion:Confirmation of ETT position using UA-US or WC is very important because of the high false result depending on SA alone. UA-US using bed-side equipment is a simple, accurate and fast method than SA compared to WC as a gold standard, so it is recommended to be one of the important theater equipments whenever possible

Use of Ultrasonography vs Clinical Assessment to Confirm Endotracheal Tube Placement by Emergency Physicians

“…Sun JT et al(2014) found that the sensitivity, specificity, positive predictive value, and negative predictive value of tracheal ultrasonography were 98.9%, 100%, 100%, and 85.7%, respectively. Arafa S et al (2018) found that the sensitivity, specificity and accuracy rates of 97%, 71.4% and 95.3%. Lahham S et al (2018) found that the trachea with 96.4% sensitivity and 33.3% specificity.…”

Endotracheal Tube Nursing Care: Current Evidence

“…Confirmation of the correct ETT placement should be rapidly done for early detection of improper positions to prevent fatal consequences (Arafa, Abouzkry, & Mohamady, 2018). The confirmation methods differ according to the hospital setting.…”