Tracheal Ultrasound for the Accurate Confirmation of the Endotracheal Tube Position in Obese Patients

Abstract

Objectives Obesity is a serious disorder that may lead to numerous difficulties in endotracheal tube (ETT) management. This study investigated the potential of tracheal ultrasound (TUS) for the accurate confirmation of the ETT position in obese patients. Methods A total of 68 obese patients undergoing tracheal intubation were enrolled in this study from January 2017 to June 2018. All patients received auscultation and TUS to evaluate the ETT position, which was ultimately verified by bronchoscopy. A correct position of the ETT was defined as placement at the trachea, whereas placement at the right/left main bronchus was classified as an incorrect position. Results We found 58 correct placements of the ETT at the trachea, 8 incorrect placements at the right main bronchus, and 2 incorrect placements at the left main bronchus. Compared with auscultation, TUS showed higher accuracy (85.29% versus 67.65%; P = .005), sensitivity (84.48% versus 67.24%; P = .005), and specificity (90.00% versus 70.00%; P < .001), as well as lower rates of false‐positive (10.00% versus 30.00%; P < .001) and false‐negative (15.52% versus 32.76%; P = .005) results for detecting the correct placement of the ETT, defined as placement at the trachea. Conclusions Tracheal ultrasound is highly sensitive and specific in confirming the ETT position in obese patients.

Cardiovascular Imaging Evaluation in COVID-19 Heart and Vascular Non-Ischaemic Involvement

“…Endotracheal intubation is the fundamental procedure for providing invasive mechanical ventilation, hence ultrasound represents a good method to confirm the correct endotracheal tube placement. Scanning the anterior cervical area above the sternal notch and under the cricoid cartilage with the linear transducer placed in a transverse position gives confirmation of the correct placement of the endotracheal tube also in obese patients [98]. The correctly placed endotracheal tube provides a hyperechoic shadow (comet sign) [99].…”

Lung Ultrasound for Detecting Tracheal and Mainstem Intubation: A Systematic Review and Meta-Analysis

“…With regard to the risk of participant selection bias, eight studies (88.8%) did not report whether participants were consecutively enrolled and thus were labeled as having unclear risk (Kerrey et al 2009;Susti c et al 2010;Sim et al 2012;Alonso Quintela et al 2014;Ramsingh et al 2016;Mori et al 2019;Parab et al 2019;Men and Yan 2020). In the assessment of reference standard, three studies (33.3%) did not describe whether the performers of fiber-optic bronchoscopy or chest X-ray were unaware of the lung-ultrasound results and thus were rated as having unclear risk Lung ultrasound for tracheal intubation position F. M. YANG et al (Sim et al 2012;Alonso Quintela et al 2014;Mori et al 2019).…”

“…The direct method of tracheal ultrasound or the indirect method of looking for pleural sliding and motion of the diaphragm have been used to confirm correct tracheal tube placement. However, the accuracy of lung ultrasound in detecting endotracheal versus mainstem intubation is inconsistent in different studies (Kerrey et al 2009;Susti c et al 2010;Sim et al 2012;Alonso Quintela et al 2014;Alvarez-D ıaz et al 2015;Ramsingh et al 2016;Mori et al 2019;Parab et al 2019;Men and Yan 2020). The primary aim of this systematic review and meta-analysis was to compile all available data from published studies on the ability of lung ultrasound to detect tracheal and mainstem intubation.…”

A.B.C. approach proposal for POCUS in COVID-19 critically ill patients

“…Fiberoptic bronchoscopy may aid in assessing the correct position of the endotracheal tube, but is not feasible in an acute setting given the resources needed and the need for fast confirmation of the correct placement of the endotracheal tube, together with aerosolisation risks. Ultrasound can be a good method for correct endotracheal tube placement [7][8][9]. Its use can be emphasized for the critical COVID-19 patient.…”