Tracheal ultrasonography and ultrasonographic lung sliding for confirming endotracheal tube placement: Faster? Reliable?

• Published in: The American journal of emergency medicine 2016
• Main Authors: Karacabey, Sinan, Sanrı, Erkman, MD, Gencer, Emin Gokhan, MD, Guneysel, Ozlem
• Format: Article
• Language: English
• Subjects: Emergency
• ISSN: 0735-6757
• DOI: 10.1016/j.ajem.2016.01.027

Abstract Background In this study we aimed to evaluate the success of ultrasonography (USG) for confirming the tube placement and timeliness by tracheal USG and ultrasonographic lung sliding in resuscitation and rapid sequence intubation. Materials and methods This study was a prospective, single-center, observational study conducted in the emergency department of a tertiary care hospital. Patients were prospectively enrolled in the study. Patients who went under emergency intubation because of respiratory failure, cardiac arrest or severe trauma included in the study. Patients with severe neck trauma, neck tumors, history of neck operation or tracheotomy and under 18 years old were excluded from the study. Results A total of 115 patients included in the study. The mean age was 67.2 ± 17.1 with age 16–95 years old. Among 115 patients 30 were cardiac arrest patients other 85 patients were non-cardiac arrest patients intubated with rapid sequence intubation. The overall accuracy of the ultrasonography was 97.18% (95% CI, 90.19–99.66%), and the value of kappa was 0.869 (95% CI, 0.77–0.96), indicating a high degree of agreement between the ultrasonography and capnography. The ulrasonography took significantly less time than capnography in total. Discussion Ultrasonography achieved high sensitivity and specificity for confirming tube placement and results faster than end-tidal carbon dioxide. Ultrasonography is a good alternative for confirming the endotracheal tube placement. Future studies should examine the use of ultrasonography as a method for real-time assessment of endotracheal tube placement by emergency physicians with only basic ultrasonographic training.