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Real-time B-mode ultrasound imaging was performed in 24 intubated patients in order to confirm the correct placement of endotracheal tubes. The large acoustic impedance mismatch between the air within the endotracheal tube cuff and the tracheal wall could be bypassed by (1) use of a foam-cuffed Bivona endotracheal tube, or by (2) cuff inflation with saline instead of air. Optimal repositioning of the endotracheal tube could be done under direct visualization. Imaging of the foam-filled and saline-filled cuffs was easier in the longitudinal (sagittal) than in the transverse view, was enhanced by a slight longitudinal to-and-fro motion of the tube, and was often improved with the use of a stand-off pad. Cases of esophageal intubation were not considered. Use of a noninvasive imaging modality such as ultrasound will spare selected patients from the radiation exposure associated with a chest x-ray. This is of value in pregnant patients and in those requiring frequent chest radiographs for the sole purpose of confirming correct endotracheal tube placement. Limitations of the techniques are discussed.

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