Sonographic detection of tracheal or esophageal intubation: A cadaver study

Tejesh, CA; Manjunath, AC; Shivakumar, SP; Vinayak, P. S.; Yatish, B; Geetha, C

doi:10.4103/1658-354x.174922

Cited by 19 publications

(7 citation statements)

References 9 publications

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“…However, current studies have used a variety of techniques, with some relying upon a static assessment, while others use dynamic assessments. 2 – 4 , 7 , 10 – 11 …”

Section: Discussionmentioning

confidence: 99%

“…However, cadaver models have been used extensively for the evaluation of ultrasound for ETT confirmation and have demonstrated similar test characteristics to live patients for this modality. 7 , 11 – 13 Additionally, we used only three cadavers in the study and it is possible this may not have fully represented the wider population. However, we intentionally used cadavers with significant differences in anatomy to best represent the variation in a larger population.…”

Section: Limitationsmentioning

confidence: 99%

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Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Gottlieb¹,

Nakitende²,

Sundaram³

et al. 2018

WestJEM

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IntroductionIn the emergency department setting, it is essential to rapidly and accurately confirm correct endotracheal tube (ETT) placement. Ultrasound is an increasingly studied modality for identifying ETT location. However, there has been significant variation in techniques between studies, with some using the dynamic technique, while others use a static approach. This study compared the static and dynamic techniques to determine which was more accurate for ETT identification.MethodsWe performed this study in a cadaver lab using three different cadavers to represent variations in neck circumference. Cadavers were randomized to either tracheal or esophageal intubation in equal proportions. Blinded sonographers then assessed the location of the ETT using either static or dynamic sonography. We assessed accuracy of sonographer identification of ETT location, time to identification, and operator confidence.ResultsA total of 120 intubations were performed: 62 tracheal intubations and 58 esophageal intubations. The static technique was 93.6% (95% confidence interval [CI] [84.3% to 98.2%]) sensitive and 98.3% specific (95% CI [90.8% to 99.9%]). The dynamic technique was 92.1% (95% CI [82.4% to 97.4%]) sensitive and 91.2% specific (95% CI [80.7% to 97.1%]). The mean time to identification was 6.72 seconds (95% CI [5.53 to 7.9] seconds) in the static technique and 6.4 seconds (95% CI [5.65 to 7.16] seconds) in the dynamic technique. Operator confidence was 4.9/5.0 (95% CI [4.83 to 4.97]) in the static technique and 4.86/5.0 (95% CI [4.78 to 4.94]) in the dynamic technique. There was no statistically significant difference between groups for any of the outcomes.ConclusionThis study demonstrated that both the static and dynamic sonography approaches were rapid and accurate for confirming ETT location with no statistically significant difference between modalities. Further studies are recommended to compare these techniques in ED patients and with more novice sonographers.

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“…However, current studies have used a variety of techniques, with some relying upon a static assessment, while others use dynamic assessments. 2 – 4 , 7 , 10 – 11 …”

Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Gottlieb¹,

Nakitende²,

Sundaram³

et al. 2018

WestJEM

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“…Prior studies have examined the ability of providers to use ultrasound to confirm ETT placement, in both static and dynamic fashions, on a variety of models including operative cases and cadavers. 12,13 This study is the first to introduce an instructional and testing protocol that examines the ability of medics to diagnose common errors associated with ETT placement in a simulated environment, including esophageal intubation, bronchial intubation, and equipment malfunction.…”

Section: Discussionmentioning

confidence: 99%

Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

Joyce

Tozer

Vitto

et al. 2020

Prehosp. Disaster med.

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Introduction: The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill. Methods: Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed. Results: All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction. Conclusions: The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.

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“…This is particularly true for resuscitation of neonates <28 weeks gestation. The current standard of practice to confirm the placement of the endotracheal tube (ETT) is with chest x-ray (CXR).The passage of the ETT into the trachea or esophagus can be discerned readily using a transverse probe position in adults and pediatric subjects [22][23][24][25]. POCUS can be used to rapidly and accurately visualize the anatomic position of the ETT position in preterm and term infants [26] (Figure 5).…”

Section: Endotracheal Tubementioning

confidence: 99%

Current Neonatal Applications of Point-of-Care Ultrasound

Kim¹,

Shalygin²,

Safarulla³

2018

Current Topics in Intensive Care Medicine

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Point-of-care ultrasound (POCUS) is an imaging modality that continues to gain acceptance in pediatric and neonatal medicine. In neonatology throughout many areas of the world, functional echocardiography performed by neonatologists has been at the forefront in the growth of POCUS compared to non-cardiac POCUS, the latter which potentially carries more opportunities for use. Despite the early adoption in obstetrics and maternal-fetal medicine, the actual bedside implementation in neonatology has unfortunately been much slower. Examples in neonatology where POCUS may continue to expand include central line placement, endotracheal tube localization, diagnosis of pneumothoraces, cardiac function assessment, and bowel viability assessment just to name a few. This chapter will be a practical synopsis of the most active uses and opportunities for POCUS in neonatology. Expanded training for neonatologists and trainees is required before widespread adoption occurs.

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Sonographic detection of tracheal or esophageal intubation: A cadaver study

Cited by 19 publications

References 9 publications

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Ability of Critical Care Medics to Confirm Endotracheal Tube Placement by Ultrasound

Current Neonatal Applications of Point-of-Care Ultrasound

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