Visualization of the vocal cords, end-tidal capnography, auscultation of bilateral chest and epigastrium are the standard methods to confirm proper ETT placement, immediately post-intubation, in our medical intensive care unit (MICU). A chest radiograph is also done to confirm ETT position. The goal of this study was to determine the accuracy of US to confirm proper ETT placement, defined as, in the trachea with bilateral lung ventilation, indicating an ETT position above the carina.
This was a prospective study. Eligible patients were 18 years or older, admitted to the MICU, that required endotracheal intubation due to their underlying clinical condition. Endotracheal intubation was performed by an anesthesiologist, intensivist or a critical care fellow under supervision. An immediate pre and post intubation US examination was performed by an intensivist who was blinded to the result of the standard confirmatory methods of ETT placement. A post-intubation chest radiograph was done in all the patients.
As per the standard methods of confirmation of ETT placement, 19/20 patients had a properly placed ETT. US examination was able to confirm correct placement in all 19 cases. 1 patient, confirmed to have a properly placed ETT by standard methods had a right main stem intubation, as seen on a post-intubation chest radiograph. US examination was able to detect a right main stem intubation in this patient. The sensitivity of US in identifying correct ETT placement was 100%, specificity 100%, diagnostic accuracy 100%, false positive rate 0% and a false negative rate of 0%.
This study demonstrates that US imaging is an accurate method to confirm proper ETT placement in an acute care setting.
US is a rapid, readily available, and a noninvasive technique that can be used as an additional tool to immediately confirm proper ETT placement in an acute care setting.
Rahul Khosla, No Financial Disclosure Information; No Product/Research Disclosure Information