Inflating the endotracheal tube cuff with saline to confirm correct depth using bedside ultrasonography

Abstract

Although bedside ultrasonography can accurately distinguish esophageal from tracheal intubation, it is not used to establish the correct depth of endotracheal tube insertion. As indirect sonographic markers of endotracheal tube insertion depth have proven unreliable, a method for visual verification of correct tube depth would be ideal. We describe the use of saline to inflate the endotracheal cuff to confirm correct endotracheal tube depth (at the level of the suprasternal notch) by bedside ultrasonography during resuscitation. This rapid technique holds promise during emergency intubation. RÉ SUMÉBien que l'é chographie au chevet des patients permette de distinguer nettement l'intubation oesophagienne de l'intubation endotraché ale, elle n'est toutefois pas utilisé e pour dé terminer si la sonde a é té posé e à la bonne profondeur dans la traché e. Comme on ne peut se fier aux marqueurs é chographiques indirects de vé rification de la profondeur de pé né tration de la sonde endotraché ale, l'idé al serait de procé der par vé rification visuelle. Il sera question ici du gonflement du ballonnet endotraché al avec une solution saline pour confirmer l'introduction de la sonde à la bonne profondeur (à la hauteur de la fourchette sternale) par é chographie au chevet des patients durant les manoeuvres de ré animation. Cette technique rapide se ré vè le prometteuse dans le contexte des intubations d'urgence.

Endotracheal Tube Placement Confirmation with Bedside Ultrasonography in the Pediatric Intensive Care Unit: A Validation Study

“…22,23 Saline has also been used to inflate the ETT cuff in other studies demonstrating the use of bedside ultrasonography to confirm correct ETT depth both during surgery with general anesthesia and emergency resuscitation. 24,25 Our study involves the use of saline in the ETT cuff solely for sonography visualization, for a brief period of time (approximately 5-7 minutes) without any reports of adverse events, such as ETT cuff rupture, need for reintubation due to dislodgement or need for ETT exchange.…”

Airway Ultrasound in Critically Ill Patients: A Narrative Review

“…3,47 Several studies have recognized ultrasonography as a tool that can be used to better identify them. 6,18,47 Laryngeal Edema In order to predict stridor, several studies have used changes in the air-column width at the level of the vocal cords before and after endotracheal cuff deflation. 9,47 Despite being a promising measurement, studies had a small sample and results should be interpreted with caution (Figure 6).…”

“…[15][16][17] Moreover, at the level of the suprasternal notch, Tessaro et al checked that inflating the endotracheal tube cuff with saline confirms the correct depth. 18 In addition, visualization of lung sliding or diaphragmatic movements can also indirectly confirm tracheal intubation.…”

Response to: "POCUS to Confirm Intubation in a Trauma Setting"

“…However, it can be more challenging to visualize an air-filled ETT cuff, and several studies have assessed the use of a saline-filled ETT cuff to confirm ETT depth without identified complications. 2,3 With regard to transtracheal ultrasound, many cervical collars have a central opening in the anterior aspect which could be used to assess for ETT placement with POCUS using the transtracheal approach. We propose that transtracheal ultrasound is an important aspect of the ETT confirmation technique and can assess for ETT location, as well as hypopharyngeal placement.…”