Point-of-care ultrasound (POCUS) of the upper airway

Abstract

Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes. Ultrasonography can differentiate tracheal, esophageal, and endobronchial intubation. Ultrasonography of the neck can accurately localize the cricothyroid membrane for emergency airway access and similarly identify tracheal rings for US-guided tracheostomy. In addition, US can identify vocal cord dysfunction and pathology before induction of anesthesia. A rapidly growing body of evidence showing ultrasonography used in conjunction with hands-on management of the airway may benefit patient care. Increasing awareness and use of POCUS for many indications have resulted in technologic advancements and increased accessibility and portability. Upper airway POCUS has the potential to become the first-line non-invasive adjunct assessment tool in airway management.

Airway ultrasound: Point of care in children—The time is now

“…Point‐of‐care ultrasonography of the airway has the potential to become the first‐line noninvasive adjunct assessment tool in airway management . It is defined as a focused and goal‐directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider.…”

Point-of-care ultrasound: a protean opportunity for perioperative care

“…There is an increasing demand for additional training for limited transesophageal imaging of thoracic contents among anesthesiologists 6 and other specialists 5 who might use this technology to guide resuscitation. Anesthesiologists are evolving POCUS applications relevant to their practices including ultrasonography of the airway 7 and imaging of the stomach and its contents. 8 Astute readers will note that our series featured here in this special issue's contents excludes USguided vascular access in adults (ubiquitous) and US-guided regional anesthesia (highly specialty specific), which most user communities do not see as POCUS, although the technology and user training share many similarities.…”

Ultrasound applications for regional anaesthetists – thinking outside the box

“…Ultrasound can identify vocal cord dysfunction and pathology before induction of anaesthesia thus highlighting potential difficulties. It may be utilized to determine airway size and predict the appropriate diameter of single-and double-lumen endotracheal tubes as well as tracheostomy tubes [6]. It appears to reliably differentiate between tracheal, oesophageal, and bronchial intubation.…”

“…Taken a step forward, ultrasonography of the neck can accurately locate the cricothyroid membrane for emergency airway access and identify tracheal rings for ultrasound-guided tracheostomy. Upper airway point-ofcare ultrasound has thus the potential to become the firstline non-invasive adjunct assessment tool in airway management [6].Much has been published in recent years on the utility of ultrasound for evaluation of gastric content. Inhalation of gastric content during induction, maintenance or emergence from anaesthesia has devastating consequences leading to significant morbidity and mortality.…”

“…Taken a step forward, ultrasonography of the neck can accurately locate the cricothyroid membrane for emergency airway access and identify tracheal rings for ultrasound-guided tracheostomy. Upper airway point-ofcare ultrasound has thus the potential to become the firstline non-invasive adjunct assessment tool in airway management [6].…”