Use of Ultrasonography vs Clinical Assessment to Confirm Endotracheal Tube Placement by Emergency Physicians

Abstract

Airway management skills are indispensable for an emergency physician. Unrecognized airway accidents such as oesophageal intubation tend to occur more in emergency room, where it is reported as 6%-16%. Various studies have compared methods used for distinguishing between endotracheal and oesophageal placement of the tube. The aim of this study is to assess the diagnostic accuracy and timeliness of ultrasonography by static method only for identification of Endo tracheal tube (ET Tube) placement in trachea in an emergency setting vs existing clinical methods. This prospective study was carried out in the emergency room from March 2020 till end of October 2022. The ultrasonography was performed 120 emergency patients only after the intubation had been completed i.e. static phase. A linear probe was used over neck to identify the predefined signs of ET intubation. Residents who perform ultrasound examination fill a form after assessment of each patient. It was found that Tracheal Intubation-USG Sensitivity was 99.1, Specificity was 91.7, Positive Predictive Value: 99.1, Negative Predictive Value was 91.7 and Accuracy was 98.3%. Ultrasonography can be used as an adjunct tool to verify the ETT position by Emergency Physicians which can be performed easily after a briefing or short-course training. This study demonstrates that US imaging has a high diagnostic accuracy to immediately confirm proper ETT placement post-intubation in an emergency setup. Therefore, it seems that ultrasonography using static technique only is a proper screening tool in determining endotracheal tube placement. Keywords: Endotracheal intubation, emergency, ultrasonography, USG Sensitivity