Diagnostic value of epigastric ultrasound and suprasternal notch ultrasound in comparison with standard capnography in confirmation of endotracheal tube placement after intubation

Authors
Saeed Majidinejad
Farhad Heydari
Mohamadreza Asadolahian
Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Endotracheal intubation is the basic method of providing a safe cross-sectional airway area and the incorrect placement can be dangerous and causes complications. So this study aimed to access the diagnostic value of color Doppler epigastric ultrasound and linear probe suprasternal notch ultrasound in comparison with standard capnography in confirmation of endotracheal tube (ETT) placement after intubation.
Materials and Methods: This diagnostic value study was conducted on 104 patients requiring intubation who were referred to the Emergency Department. After the intubation, color Doppler epigastric ultrasound and suprasternal notch ultrasound as well as the standard capnography were used to confirm the placement ETT.
Results: The sensitivity and specificity of color Doppler epigastric ultrasound were 97.96% and 100%, for suprasternal notch ultrasound were 98.98% and 66.67%, and for combination of the both methods were 96.94% and 100% respectively that showed the significant diagnostic value in the confirmation of ETT placement (P < 0.001). The mean of elapsed time to confirm the ETT placement by the standard capnography method (17.95 ± 2.45 s) was significantly more than the two methods of epigastric ultrasound (10.38 ± 4.65 s) and suprasternal notch ultrasound (5.08 ± 4.45 s) as well as the combined method with the mean of 15.46 ± 8.31 s (P < 0.001).
Conclusion: The results of this study showed that although ultrasound is a potentially accurate, fast, and reliable method to confirm the endotracheal tube placement, but suprasternal notch ultrasound is considered to be a more appropriate diagnostic technique due to its higher sensitivity and less detection time compared to epigastric ultrasound and combined method.

Keywords

1.
McGill JW, Reardon RF. Tracheal intubation. In: Roberts JR, Hedges JR, Custalow CB, editors. Clinical Procedures in Emergency Medicine. 5th ed. New York: McGraw Hill; 2010. p. 58-98.  Back to cited text no. 1
    
2.
Thomas VK, Paul C, Rajeev PC, Palatty BU. Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting. Indian J Crit Care Med 2017;21:257.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Gupta NR, George D, Babukutty LJ, Pradeep V. Ultrasound as a tool for endotracheal tube confirmation in patients with or without difficult airway undergoing elective surgery. J Evol Med Dent Sci 2017;6:3124-8.  Back to cited text no. 3
    
4.
Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: Adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122 18 Suppl 3:S729-67.  Back to cited text no. 4
    
5.
Grmec S. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med 2002;28:701-4.  Back to cited text no. 5
    
6.
Raphael DT, Benbassat M, Arnaudov D, Bohorquez A, Nasseri B. Validation study of two-microphone acoustic reflectometry for determination of breathing tube placement in 200 adult patients. Anesthesiology 2002;97:1371-7.  Back to cited text no. 6
    
7.
Li J. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation. J Emerg Med 2001;20:223-9.  Back to cited text no. 7
    
8.
Hosseini JS, Talebian MT, Ghafari MH, Eslami V. Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view. Int J Crit Illn Inj Sci 2013;3:113-7.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Gottlieb M, Holladay D, Peksa GD. Ultrasonography for the confirmation of endotracheal tube intubation: A systematic review and meta-analysis. Ann Emerg Med 2018;72:627-36.  Back to cited text no. 9
    
10.
Werner SL, Smith CE, Goldstein JR, Jones RA, Cydulka RK. Pilot study to evaluate the accuracy of ultrasonography in confirming endotracheal tube placement. Ann Emerg Med 2007;49:75-80.  Back to cited text no. 10
    
11.
Gerscovish EO, Cronan M, McGaban JP. Ultrasonographic evaluation of diaphragmatic motion. J Ultrasound Med 2001;20:597-604.  Back to cited text no. 11
    
12.
Hsieh KS, Lee CL, Lin CC, Huang TC, Weng KP, Lu WH. Secondary confirmation of endotracheal tube position by ultrasound image. Crit Care Med 2004;32:S374-7.  Back to cited text no. 12
    
13.
You-Ten KE, Siddiqui N, Teoh WH, Kristensen MS. Point-of-care ultrasound (POCUS) of the upper airway. Can J Anaesth 2018;65:473-84.  Back to cited text no. 13
    
14.
Gottlieb M, Holladay D, Burns KM, Nakitende D, Bailitz J. Ultrasound for airway management: An evidence-based review for the emergency clinician. Am J Emerg Med 2020;38:1007-13.  Back to cited text no. 14
    
15.
Chun R, Kirkpatrick AW, Sirois M, Sargasyn AE, Melton S, Hamilton DR, et al. Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement. Prehosp Disaster Med 2004;19:366-9.  Back to cited text no. 15
    
16.
Wong KW, Chan HH, Wong CP, Chan MY, Chau JC, Wong TW. Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position. Am J Emerg Med 2017;35:333-6.  Back to cited text no. 16
    
17.
Weaver B, Lyon M, Blaivas M. Confirmation of endotracheal tube placement after intubation using the ultrasound sliding lung sign. Acad Emerg Med 2006;13:239-44.  Back to cited text no. 17
    
18.
Zamani M, Esfahani MN, Joumaa I, Heydari F. Accuracy of real-time intratracheal bedside ultrasonography and waveform capnography for confirmation of intubation in multiple trauma patients. Adv Biomed Res 2018;7:95.  Back to cited text no. 18
    
19.
Ahmadi K, Pishbin E, Ramezani M, Ibrahimi M. Ultrasound as a secondary method in confirming the location of the tracheal tube. Med J Mashhad Univ Med Sci 2013;56:236-42.  Back to cited text no. 19
Advanced Biomedical Research
Volume 2023, January
January 2023
Pages 1-6