Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement

Werner, Sandra; Smith, Charles E.; Goldstein, Jessica R.; Jones, Robert A.; Cydulka, Rita K.

doi:10.1016/j.annemergmed.2006.07.004

Cited by 153 publications

(107 citation statements)

References 7 publications

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“…1. PRISMA sensitivity and specificity and Werner et al [11] reported 100% sensitivity and 97% specificity. The use of ultrasound may be limited by availability of both expertise and equipment.…”

Section: Excluded (Not Meeting Criteria) N=33mentioning

confidence: 99%

Endotracheal tube verification in adult mechanically ventilated patients

2015

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Objective. To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients.Methods. An integrative literature search was conducted in 2012 -2013 of research citations published in English on the topic of discussion. Electronic databases searched were: the Cumulative Index of Nursing and Allied Health (CINAHL), MEDLINE, PubMed, the Joanna Briggs Institute (JBI) systematic review library, the Cochrane Library and the National Guidelines Clearinghouse. In addition, reference lists of articles, conference summaries and hand searching was performed. Citations were selected based on the inclusion and exclusion criteria as decided upon by the researchers. The process of critical appraisal was done by the researchers as well as an independent reviewer, all skilled in the research methodology and subject matter related to the topic of discussion. A total of 45 articles were included for critical appraisal. On completion of the critical appraisal, which was done by two independent reviewers, 34 articles were excluded and 11 articles were included in the integrative review analyses. Data were extracted following the critical appraisal process. Owing to the heterogeneity of studies, a metasynthesis could not be done. Results. Based on the reviewed studies, various methods have been identified to verify ETT placement in adult mechanically ventilated patients, namely ultrasonography, the use of centimetre scale printed on the ETT, manual cuff palpation, bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography. Both ultrasonography and capnography had excellent sensitivity and specificity in verifying ETT placement. Conclusion. Although there are various methods reported for ETT verification, the review results recommended ultrasonography and capnography as the most accurate and reliable verification methods.

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Section: Excluded (Not Meeting Criteria) N=33mentioning

confidence: 99%

Endotracheal tube verification in adult mechanically ventilated patients

2015

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“…Ultrasonography has shown to be a safe, reliable and noninvasive way of confirming the correct position of the endotracheal tube (ETT) with high sensitivity and specificity. 18,19 In a recent study, the authors used a combination of transcricoid membrane ultrasonography and ultrasonographic sliding lung sign in 30 patients in emergency department to confirm endotracheal intubation and found the sensitivity, specificity, positive predictive value and negative predictive value to be 100% each. 20 The US can be used to directly visualise the ETT being positioned in the trachea by an external scanning technique at the level of the cricoid at the time of intubation.…”

Section: Tracheal Intubationmentioning

confidence: 99%

“…[16][17][18] Capnography has proven to be the most reliable although it has its own limitations. In cardiac arrest and low cardiac output states, its sensitivity may be very low as end tidal CO 2 may be undetectable.…”

Section: Tracheal Intubationmentioning

confidence: 99%

Role of Ultrasound in Airway Assessment and Management

Kajekar¹,

Mendonca²,

Gaur³

2010

IJUTPC

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Ultrasound has gained widespread popularity in several aspects of perioperative and intensive care management. There is now growing evidence of it being a useful tool in the assessment and management of potentially difficult airway. With advances in technology and greater understanding of sonographic clinical anatomy, a greater insight into its uses has been gained. This article gives an overview of the possible clinical applications of ultrasound in day to day airway management in anaesthesia and intensive care.

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“…It is already established as an accurate test to differentiate tracheal from esophageal intubation. [1][2][3][4][5][6][7][8] An ETT cuff that is located at the level of the suprasternal notch correlates to correct depth of ETT insertion. [29][30][31][32] A cuff filled with air, however, cannot be reliably distinguished from the surrounding air-filled trachea.…”

Section: Cjem N Jcmumentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Air transmits the ultrasound beam poorly, leading to an artifact called ''dirty shadowing.'' With or without an ETT in place, the trachea appears as an area of dirty shadowing on a sonogram because it is filled with air.…”

mentioning

confidence: 99%

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

Tessaro

Arroyo

Haines

et al. 2015

CJEM

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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.

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Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement

Cited by 153 publications

References 7 publications

Endotracheal tube verification in adult mechanically ventilated patients

Endotracheal tube verification in adult mechanically ventilated patients

Role of Ultrasound in Airway Assessment and Management

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

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