The accuracy of ultrasonography in confirming endotracheal tube placement in emergency department

 

 

Abstract              Background: Over the past few years, ultrasonography is increasingly being used to confirm the correct placement of endotracheal tube (ETT). In our study, we aimed to compare it with the traditional clinical methods and the gold standard quantitative waveform capnography. Two primary outcomes were measured in our study. First was the sensitivity and specificity of ultrasonography against the other two methods to confirm endotracheal intubation. The second primary outcome assessed was the time taken for each method to confirm tube placement in an emergency setting. Methods: This is a single ‑ centered, prospective cohort study conducted in an emergency department of a tertiary care hospital. We included 250 patients with indication of emergency intubation by convenient sampling. The intubation was performed as per standard hospital protocol. As part of the study protocol, ultrasonography was used to identify ETT placement simultaneously with the intubation procedure along with quantitative waveform capnography (end‑tidal carbon dioxide) and clinical methods. Result: Out of the 250 intubation attempts, the overall accuracy of ultrasonography was 98.80% .The sensitivity ,specificity, positive predictive value and negative predictive value of ultrasonography method for tracheal intubation confirmation were 98.72% 100%,100%,84.21% respectively. If ultrasonography is as specific and sensitive as wave form capnography It can be used instead if wave form capnography is not available. Conclusion: Ultrasonography confirmed tube placement with comparable sensitivity and specificity to quantitative waveform capnography and clinical methods.

Key Word: Capnography, emergency, intubation, ultrasonography.