Variation in the accuracy of ultrasound for the detection of intubation by endotracheal tube size

Gottlieb, Michael; Holladay, Dallas; Nakitende, Damali; Hexom, Braden; Patel, Urvi; Serici, Anthony; Shah, Shital; Bailitz, John

doi:10.1016/j.ajem.2018.07.026

Cited by 17 publications

(7 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A recent study comparing transducer types did not demonstrate a difference in accuracy but noted that providers preferred the linear transducer . Of note, most studies did not describe the size of the ETT used, although recent literature has suggested that accuracy remains consistent regardless of ETT size …”

Section: Caveatsmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

heading Transtracheal ultrasound can accurately guide and verify endotracheal tube placement Positive LR findings LR+: 34 for transtracheal ultrasound confirmation of endotracheal tube placement Negative LR findings LR-: 0.01 for transtracheal ultrasound confirmation of endotracheal tube placement Who was in the studies 17 studies comprising 1,595 patients, with 12 studies conducted in the ED NARRATIVEEndotracheal intubation is a common intervention in the emergency department (ED) and prehospital setting. Direct visualization of endotracheal tube (ETT) placement through the vocal cords is limited at times, and esophageal intubation can be dangerous if not recognized. 1 Therefore, additional methods (e.g., lung auscultation, esophageal detector devices, capnography) are necessary for confirmation of tube placement. However, these methods are not always reliable. 2-4 Point-of-care ultrasonography (POCUS) has increasingly been used as a potential confirmatory tool for ETT confirmation. The 2015 Advanced Cardiac Life Support guidelines state that POCUS may be a useful adjunct for ETT confirmation. 5The meta-analysis discussed here included prospective observational or randomized controlled trials evaluating transtracheal POCUS for ETT placement confirmation in patients older than 18 years. 6 All studies included a confirmatory test for comparison (e.g. end-tidal capnography, colorimetric capnography, direct visualization). The primary outcome was diagnostic accuracy of transtracheal POCUS for ETT confirmation, with subgroup analyses including location, provider specialty, provider experience, transducer type, and POCUS technique. The authors also assessed time to confirmation as a secondary outcome.The authors of the meta-analysis identified 17 studies (n = 1,595 patients) that met their inclusion criteria. Twelve studies were performed in the ED, and five studies were conducted in the operating room. Overall, POCUS was 98.7% sensitive (95% confidence interval [CI] = 97.8% to 99.2%) and 97.1% specific (95% CI = 92.4% to 99.0%), with a positive likelihood ratio (LR+) of 34.4 (95% CI = 12.7 to 93.1) and a negative likelihood ratio (LR-) of 0.01 (95% CI = 0.01 to 0.02). Area under the receiver operating characteristic curve demonstrated a high degree of accuracy (area under the curve = 0.994; 95% CI = 0.982 to 0.998). The mean time to confirmation was 13.0 seconds (95% CI = 12.0 to 14.0 From the

show abstract

Section: Caveatsmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…As for it, the performance of ultrasound to verify the correct positioning of the intubation tube had a sensitivity of 99% and a specificity of 84% for patients in CA [ 11 ]. Furthermore, another study showed that the size of the intubation tube (6.0 to 8.0 mm) had no impact on the diagnostic accuracy of ultrasound [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Detecting cervical esophagus with ultrasound on healthy voluntaries: learning curve

2023

View full text Add to dashboard Cite

Background The objective of this study was to determine the learning curve of tracheal−esophageal ultrasound by prehospital medical and paramedical staff. Methods A single-center prospective study was carried out at a French EMS (SAMU 92). Volunteer participants first received a short theoretical training through e-learning, followed by two separate hands-on workshops on healthy volunteers, spaced one to two months apart. Learners were timed to obtain the tracheal–esophageal ultrasound target image 10 consecutive times. The first workshop was intended to perform a learning curve, and the second was to assess unlearning. The secondary objectives were to compare performance by profession and by previous ultrasound experience. Results We included 32 participants with a mean age of 38 (± 10) years, consisting of 56% men. During the first workshop, the target image acquisition time was 20.4 [IQR: 10.6;41] seconds on the first try and 5.02 [3.72;7.5] seconds on the 10th (p < 0.0001). The image acquisition time during the second workshop was shorter compared to the first one (p = 0.016). In subgroup analyses, we found no significant difference between physicians and nurses (p = 0.055 at the first workshop and p = 0.164 at the second) or according to previous ultrasound experience (p = 0.054 at the first workshop and p = 0.176), counter to multivariate analysis (p = 0.02). Conclusions A short web-based learning completed by a hands-on workshop made it possible to obtain the ultrasound image in less than 10 s, regardless of the profession or previous experience in ultrasound.

show abstract

“… 21 Studies have also demonstrated that the accuracy remains consistent regardless of ETT size or transducer type. 22 , 23 Additionally, the learning curve for identifying ETT placement with transtracheal POCUS has been suggested to be relatively short. 24 Importantly, this modality offers the unique benefit that it does not require positive pressure ventilation, thereby minimizing additional exposure to staff.…”

Section: Role Of Point-of-care Ultrasound For Intubation Confirmationmentioning

confidence: 99%

Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients

Gottlieb

Alerhand

Long

2020

WestJEM

Self Cite

View full text Add to dashboard Cite

The novel coronavirus disease of 2019 (COVID-19) is associated with significant morbidity and mortality, as well as large numbers of patients requiring endotracheal intubation. While much of the literature has focused on the intubation technique, there is scant discussion of intubation confirmation. Herein, we discuss the limitations of traditional confirmatory approaches, summarize the literature supporting a role for point-of-care ultrasound in this application, and propose an algorithm for intubation confirmation among COVID-19 patients.

show abstract

Variation in the accuracy of ultrasound for the detection of intubation by endotracheal tube size

Cited by 17 publications

References 10 publications

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Detecting cervical esophagus with ultrasound on healthy voluntaries: learning curve

Point-of-Care Ultrasound for Intubation Confirmation of COVID-19 Patients

Contact Info

Product

Resources

About