Abstract
Objective
To evaluate the accuracy of tracheal ultrasonography for confirming the endotracheal tube placement during patients’ intubation.
Patients and methods
The current study was a prospective, randomized study performed at the ICU of Al-Hussein Hospital, Cairo. Intubated for respiratory failure, cardiac arrest or other medical causes were included in the current study. Real-time tracheal ultrasonography was conducted during intubation with the ultrasound probe placed transversely over the trachea above the suprasternal notch for confirming the tube position, either tracheal or esophageal. The standard method for confirming endotracheal tube placement include clinical evaluation and rapid bronchoscopic confirmation. The main outcomes were the degree of accuracy and timeliness of tracheal ultrasound in confirming endotracheal tube placement.
Results
Forty patients eligible for endotracheal intubation were randomized in the current study and only four (10%) patients had confirmed esophageal intubations. Our results concluded that tracheal ultrasound had a diagnostic accuracy of 97.5% in the detection of endotracheal tube site. The sensitivity was 97.2%, while the specificity was 100%. Tracheal ultrasound had a positive predictive value of 100%, while the negative predictive value was 80%. The total operating time of ultrasonography was significantly lower than that of bronchoscopy.
Conclusion
Real-time ultrasound of the trachea is an accurate, feasible, and fast method in confirming endotracheal tube placement.
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References
Schwartz DE, Matthay MA, Cohen NH. Death and other complications of emergency airway management in critically ill adults. A prospective investigation of 297 tracheal intubations. Anesthesiology 1995;82:367–76.2.
Mort TC. Unplanned tracheal extubation outside the operating room:a quality improvement audit of hemodynamic and tracheal airway complications associated with emergency tracheal reintubation. Anesth Analg 1998;86:1171–6.3.
Salem MR, Baraka A. Confirmation of tracheal intubation. In:Benumof JL, editor. Airway management:principles and practice. New York, NY:CV Mosby Co; 1996. pp. 531–560.
ACEP Board of Directors. Verification of endotracheal tube placement. Ann Emerg Med 2009;54:141–142.
MaG,DavisDP, Schmitt J. The sensitivity and specificity of transcricothyroid ultrasonographyto confirmendotracheal tubeplacement inacadavermodel. J Emerg Med 2007;32:405–407.
ECC Committee, Subcommittees and Task Forces of the American Heart Association. American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Part 8.1:Adjuncts for airway control and ventilation. Circulation 2010;112:S729–S735.
Takeda T, Tanigawa K, Tanaka H, Hayashi Y, Goto E, Tanaka K. The assessment of three methods to verify tracheal tube placement in the emergency setting. Resuscitation 2003;56:153–157.
Levine RL, Wayne MA, Miller CC. End-tidal carbon dioxide and outcome of out-of-hospital cardiac arrest. N Engl J Med 1997;337:301–306.
Clyburn P, Rosen M. Accidentaloesophageal intubation. Br J Anaesth 1994;73:55–63.
Koppel JN. Learning fiberoptic-guided endotracheal intubation. Mt Sinai J Med 1995;62:41–46.
Abbasi S, Farsi D, Zare MA, Hajimohammadi M. Direct ultrasound methods:a confirmatory technique for proper endotrachealintubation in the emergency department. Eur J Emerg Med 2015;22:10–16.
Chou HC, TsengWP,Wang CH. Tracheal rapid ultrasound exam(T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation 2011;82:1279–1284.
Sayah AJ, Peacock WF, Overton DT. End-tidal CO2 measurement in the detection of esophageal intubation during cardiac arrest. Ann Emerg Med 1990;19:857–860.
Deiorio NM. Continuous end-tidal carbon dioxide monitoring for confirmation of endotracheal tube placement is neither widely available nor consistently applied by emergency physicians. Emerg Med J 2005;22:490–493.
Muslu B, Sert H, Kaya A, Demircioglu RI, Gözdemir M, Usta B, et al. Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients. J Ultrasound Med 2011;30:671–676.
Deakin CD, Nolan JP, Soar J. European resuscitation council guidelines for resuscitation2010. Section 4. Adult advanced life support. Resuscitation 2010;81:1305–1352.
Deakin CD, Morrison LJ, Morley PT. International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Part 8:advanced life support. Resuscitation 2010; 81:e93–e174.
Hsieh KS, Lee CL, Lin CC. Secondary confirmation of endotracheal tube position by ultrasound image. Crit Care Med 2004; 32(Suppl):S374–S377.
Weaver B, Lyon M, Blaivas M. Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad Emerg Med 2006;13:239–244.
Rosenstein AL, Jones RA, Werner SL, Meurer WJ. Ultrasound as a tool to confirm tracheal intubation [abstract]. Acad Emerg Med 2004; 11 (Suppl):5.
Werner SL, Smith CE, Goldstein JR. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med 2007;49:75–80.
Milling TJ. Transtracheal 2-D ultrasound for identification of esophageal intubation. J Emerg Med 2007;32:409–414.
Karacabey S, Sanri E, Gencer EG, Guneysel O. Tracheal ultrasonography and ultrasonographic lung sliding for confirming endotracheal tube placement:speed and reliability. Am J Emerg Med 2016;34:953–956.
Chou EH, Dickman E, Tsou PY, Tessaro M, Tsai YM. Ultrasonography for confirmation of endotracheal tube placement:a systematic review and meta-analysis. Resuscitation 2015;90:97–103.
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Kabil, A.E., Ewis, A.M., Al-Ashkar, A.M. et al. Real-time tracheal ultrasonography for confirming endotracheal tube placement. Egypt J Bronchol 12, 323–328 (2018). https://doi.org/10.4103/ejb.ejb_88_17
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DOI: https://doi.org/10.4103/ejb.ejb_88_17