Dynamic Anatomic Relationship of the Esophagus and Trachea on Sonography

Tsung, James W.; Fenster, Daniel; Kessler, David; Novik, Joseph

doi:10.7863/jum.2012.31.9.1365

Cited by 30 publications

(26 citation statements)

References 13 publications

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“…If this was not possible, an additional maneuver was employed. Pressure was placed on the cricoid cartilage 9 or the esophagus; the posterior trachea was pushed manually to the left. When it was not possible to obtain an esophageal image by these maneuvers, the same procedures were attempted on the right side of the trachea.…”

Section: Methodsmentioning

confidence: 99%

Ultrasound‐Guided Nasogastric Feeding Tube Placement in Critical Care Patients

2015

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Section: Methodsmentioning

confidence: 99%

Ultrasound‐Guided Nasogastric Feeding Tube Placement in Critical Care Patients

2015

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“…Furthermore, although in our protocol direct visualization of ETT in the trachea and the lung‐sliding sign were mainly used to differentiate correct tracheal intubation from esophageal or endobronchial mainstem intubation, we were unable to evaluate the lung pulse sign (pulsatile movement of the pleura synchronized with cardiac motion) as a means of detecting endobronchial mainstem intubation. An empty esophagus and lung pulse sign is useful for ruling out esophageal intubation and detecting endobronchial mainstem intubation, because of the difficulty of directly visualizing ETT due to echogenic structures and/or shadow artifacts of the trachea or the lung‐sliding sign due to insufflated gas into the stomach . Therefore, the introduction of these signs into our protocol may have enhanced the diagnostic accuracy of the 3‐point approach with ultrasonography.…”

Section: Discussionmentioning

confidence: 99%

“…The patients were placed in a supine position, and the probe was placed transversely on the anterior neck at the level of the cricothyroid membrane (Figure ). Normally, the trachea is visible in the center of the field, while the esophagus is more often visible in the left paratracheal space deep to the left lobe of the thyroid gland . The trachea forms a semicircular hypoechoic structure with a reverberation artifact from the air‐mucosa interface.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Accuracy of a 3‐Point Ultrasound Protocol to Detect Esophageal or Endobronchial Mainstem Intubation in a Pediatric Emergency Department

Mori

Nomura

Hagiwara

et al. 2019

J of Ultrasound Medicine

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Objectives The aim of this study was to evaluate the diagnostic accuracy of the 3‐point approach with ultrasonography for confirming endotracheal tube (ETT) placement in pediatric patients. Methods This was a prospective study conducted at a tertiary care center in Japan between March 2014 and March 2016. Children aged 0 to 18 years requiring endotracheal intubation in our emergency department (ED) who underwent ultrasonography for confirming ETT placement were enrolled. Patients who had already undergone a tracheotomy or intubation before arrival at our ED or who had severe neck injuries hindering ultrasonography were excluded. Quantitative capnography and portable chest x‐ray imaging were used as the reference standard for the confirmation of proper ETT placement. The main outcome was the diagnostic accuracy of the 3‐point approach with ultrasonography for detecting inappropriate ETT placement. Results In total, 68 patients were enrolled. The median age was 17 months (interquartile range, 8–40), and 51.4% were males. Three (4.4%) and 7 (10.3%) patients had esophageal and endobronchial mainstem intubation, respectively. The patients received emergency intubation due to a dysfunction of the central nervous system (45.6%) or respiratory failure (22.0%). The sensitivity and specificity of esophageal versus tracheal intubation was 100% (95% confidence interval [CI], 54.9%–100.0%) and 100% (95% CI, 97.9%–100.0%), respectively, whereas for endobronchial mainstem intubation versus tracheal intubation, the sensitivity and specificity was 85.7% (95% CI, 56.7%–96.0%) and 98.3% (95% CI, 94.8%–99.5%), respectively. Agreement between the reviewers was high (kappa coefficient, 0.78). Conclusion The 3‐point approach with ultrasonography was a feasible method for detecting esophageal and endobronchial mainstem intubation in pediatric patients.

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“…Based on the results of point‐of‐care LUS, the clinician can immediately make a therapeutic decision. This may be potentially lifesaving in assessing a neonate with undifferentiated respiratory distress, respiratory failure, or ventilation problems …”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport

Jagła

Grudzień

Starzec

et al. 2019

J of Clinical Ultrasound

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Purpose Lung ultrasound (LUS) at the point‐of‐care is a new method that is increasingly used in neonatology. The aim of this study was to determine the utility of the addition of LUS prior to the interhospital transport of neonates with respiratory failure. Methods LUS was performed on 50 newborns with respiratory failure prior to transport to a tertiary neonatal intensive care unit. We analyzed the performance of LUS for diagnosing the cause of respiratory failure, the concordance between LUS, chest X‐ray (CXR) and final clinical diagnosis, and the impact of LUS on clinical decision making before transport. Results LUS sensitivity for the diagnosis of respiratory distress syndrome was 91.3% (95%CI: 70.5‐98.5%), and specificity was 92.6% (95%CI: 74.2‐98.7%), whereas sensitivity and specificity of CXR were 69.6% (95%CI: 47.0‐85.9%) and 81.5% (95%CI: 61.2‐92.9%), respectively. For the recognition of pneumothorax (PTX) LUS had a sensitivity of 83.3% (95%CI: 36.5‐99.1%) and a specificity of 100% (95%CI: 89.9‐100%). For CXR, sensitivity was 16.7% (95%CI: 0.01‐63.5%) and specificity was 97.7% (95%CI: 86.4‐99.9%). The agreement between LUS and CXR in diagnosing the cause of respiratory failure was substantial (κ of 0.57 [95%CI: 0.40‐0.74]) and the agreement between LUS and the final clinical diagnosis was very good (κ of 0.86 [95%CI: 0.74‐0.98]). In 42% of the patients, a LUS examination prior to transport indicated the need for endotracheal tube repositioning or PTX decompression. Conclusion LUS may be a reliable imaging technique for differentiating the causes of respiratory failure before neonatal transport. Use of LUS may optimize the care of infants during transport.

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Dynamic Anatomic Relationship of the Esophagus and Trachea on Sonography

Abstract: With cricoid pressure applied using a linear transducer, the esophagus was visualized lateral to the trachea in all children and young adults. Visualizing an empty esophagus by point-of-care sonography may be feasible to confirm endotracheal tube placement by a process of elimination.

Cited by 30 publications

References 13 publications

Ultrasound‐Guided Nasogastric Feeding Tube Placement in Critical Care Patients

Ultrasound‐Guided Nasogastric Feeding Tube Placement in Critical Care Patients

Diagnostic Accuracy of a 3‐Point Ultrasound Protocol to Detect Esophageal or Endobronchial Mainstem Intubation in a Pediatric Emergency Department

Lung ultrasound in the diagnosis of neonatal respiratory failure prior to patient transport

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