Accuracy of ultrasound for endotracheal intubation between different transducer types

Gottlieb, Michael; Holladay, Dallas; Burns, Katharine M.; Gore, Stephen R.; Wulff, Collin; Shah, Shital; Bailitz, John

doi:10.1016/j.ajem.2019.03.016

Cited by 19 publications

(11 citation statements)

References 12 publications

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“…Transducer type varied between studies, but there was no statistically significant difference in accuracy present on subgroup analysis. A recent study comparing transducer types did not demonstrate a difference in accuracy but noted that providers preferred the linear transducer . Of note, most studies did not describe the size of the ETT used, although recent literature has suggested that accuracy remains consistent regardless of ETT size …”

Section: Caveatsmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

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heading Transtracheal ultrasound can accurately guide and verify endotracheal tube placement Positive LR findings LR+: 34 for transtracheal ultrasound confirmation of endotracheal tube placement Negative LR findings LR-: 0.01 for transtracheal ultrasound confirmation of endotracheal tube placement Who was in the studies 17 studies comprising 1,595 patients, with 12 studies conducted in the ED NARRATIVEEndotracheal intubation is a common intervention in the emergency department (ED) and prehospital setting. Direct visualization of endotracheal tube (ETT) placement through the vocal cords is limited at times, and esophageal intubation can be dangerous if not recognized. 1 Therefore, additional methods (e.g., lung auscultation, esophageal detector devices, capnography) are necessary for confirmation of tube placement. However, these methods are not always reliable. 2-4 Point-of-care ultrasonography (POCUS) has increasingly been used as a potential confirmatory tool for ETT confirmation. The 2015 Advanced Cardiac Life Support guidelines state that POCUS may be a useful adjunct for ETT confirmation. 5The meta-analysis discussed here included prospective observational or randomized controlled trials evaluating transtracheal POCUS for ETT placement confirmation in patients older than 18 years. 6 All studies included a confirmatory test for comparison (e.g. end-tidal capnography, colorimetric capnography, direct visualization). The primary outcome was diagnostic accuracy of transtracheal POCUS for ETT confirmation, with subgroup analyses including location, provider specialty, provider experience, transducer type, and POCUS technique. The authors also assessed time to confirmation as a secondary outcome.The authors of the meta-analysis identified 17 studies (n = 1,595 patients) that met their inclusion criteria. Twelve studies were performed in the ED, and five studies were conducted in the operating room. Overall, POCUS was 98.7% sensitive (95% confidence interval [CI] = 97.8% to 99.2%) and 97.1% specific (95% CI = 92.4% to 99.0%), with a positive likelihood ratio (LR+) of 34.4 (95% CI = 12.7 to 93.1) and a negative likelihood ratio (LR-) of 0.01 (95% CI = 0.01 to 0.02). Area under the receiver operating characteristic curve demonstrated a high degree of accuracy (area under the curve = 0.994; 95% CI = 0.982 to 0.998). The mean time to confirmation was 13.0 seconds (95% CI = 12.0 to 14.0 From the

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Section: Caveatsmentioning

confidence: 99%

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Long

Koyfman

Gottlieb

2019

Academic Emergency Medicine

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“…Ultrasound has been shown to be very accurate in excluding esophageal intubation in the hands of practitioners skilled in its use. 19 , 20 If the tube is in the esophagus a “double tract sign” can be seen, which is an echogenic shadow observed lateral to the trachea and is caused by the presence of the tube in the esophagus. A recent systematic review of 17 studies found that transtracheal ultrasound was 99% sensitive and 97% specific for determination of tube placement with a mean time to confirmation of 13 s. 20 However, similar to flexible endoscopy, if the ultrasound machine is not readily available or the clinician is not adequately skilled in its use, unacceptable delays may occur.…”

Section: Valid Alternative Techniques To Exclude Esophageal Intubationmentioning

confidence: 99%

Preventing unrecognized esophageal intubation in the emergency department

2023

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Tracheal intubation is a commonly performed procedure on critically ill patients in the emergency department. It is associated with many serious complications, one of the most dangerous being unrecognized esophageal intubation, which can result in anoxic brain injury, cardiac arrest, or death. It is the responsibility of the emergency physician to do everything possible to avoid this devastating complication. Preventing unrecognized esophageal intubation requires a two‐pronged approach. First, the inadvertent placement of intended tracheal tubes into the esophagus must be reduced as much as is humanly possible. This can be achieved with the routine use of video laryngoscopes for emergency department intubations. Numerous studies have demonstrated that use of video laryngoscopes can significantly reduce the occurrence of esophageal intubation, presumably by providing an improved view of the larynx. Second, if an esophageal intubation inadvertently occurs, it must be rapidly identified and appropriately addressed. The cornerstone of rapid identification is the use of continuous waveform capnography to detect exhaled carbon dioxide. Capnography has been shown to be the most accurate method to determine tube placement after intubation. Standard clinical examinations, for example, auscultation of breath sounds, visualization of chest excursion, and observation of condensation in the tube, have all been demonstrated in studies to be unreliable and thus should not be used to exclude esophageal intubation. Recently, the Project for Universal Management of Airways, an international collaborative of airway experts from anesthesiology, critical care and emergency medicine, published evidence‐based guidelines to specifically address the issue of preventing unrecognized esophageal intubation. These guidelines, which have received endorsement from several prominent airway societies, including the Society for Airway Management, the Difficult Airway Society, and the European Airway Management Society, will be briefly discussed in this review.

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“…Furthermore, curvilinear and linear probes were used to determine ET position and intubation depth. One study found no statistical difference in the diagnostic accuracy of the two, but the linear probe takes less time [ 48 ].…”

Section: Discussionmentioning

confidence: 99%

Applications of Airway Ultrasound for Endotracheal Intubation in Pediatric Patients: A Systematic Review

Liu

2023

JCM

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Endotracheal intubation is a challenging procedure for pediatric patients. Airway ultrasound as a new technology is suitable for aiding this process, but its diagnostic value remains unclear. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Chinese biomedical literature database to summarize specific applications of airway ultrasound in each step of endotracheal intubation in pediatric patients. Diagnostic accuracy and 95% confidence interval were used as outcomes. In total, 33 studies (6 randomized controlled trials and 27 diagnostic studies) with 1934 airway ultrasound examinations were included. Population included neonates, infants, and older children. Airway ultrasound could be used to determine the endotracheal tube size and confirm endotracheal intubation and intubation depth; the diagnostic accuracy for all these factors was 23.3–100%, 90.6–100%, and 66.7–100%, respectively. Furthermore, the accuracy of airway ultrasound in predicting endotracheal tube size was consistently higher than traditional methods, such as height formula, age formula, and the width of the little finger. In conclusion, airway ultrasound has unique advantages for confirming successful endotracheal intubation in pediatric patients, and it may become an effective auxiliary tool in this field. There is a need to develop a unified airway ultrasound protocol to conduct clinical trials and practice in the future.

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Accuracy of ultrasound for endotracheal intubation between different transducer types

Cited by 19 publications

References 12 publications

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Preventing unrecognized esophageal intubation in the emergency department

Applications of Airway Ultrasound for Endotracheal Intubation in Pediatric Patients: A Systematic Review

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