Diagnostic accuracy of ultrasonography for the confirmation of endotracheal tube intubation: a systematic review and meta-analysis

Abstract

Aim: Despite several studies and reviews reporting data accuracy of ultrasonography for confirmation of endotracheal intubation, there has been limited pooled evidence summarizing the diagnostic accuracy of this imaging modality, especially based on recent evidence. Hence, the current study reviews the recent literature and conducts a meta-analysis to compare the accuracy of ultrasonography for the confirmation of endotracheal tube placement.Material and methods: We conducted a systematic search for all studies reporting the diagnostic accuracy of ultrasonography in the databases of Medline, EMBASE,PubMed Central, ScienceDirect, Google Scholar & Cochrane library from inception till December 2021. Meta-analysis was performed using STATA software “midas” package.Results: Thirty-eight studies with 3,268 participants were included. Thepooled sensitivity was 98% (95% CI, 97%-99%) and specificity was 95% (95% CI, 90%-98%), respectively. The AUC was 0.98 (95%CI: 0.96-1.00). The pooled DOR was 1090 (95% CI, 408-2910). Pooled LRP was 19 (95% CI, 9-39) and pooled LRN was 0.02 (0.01-0.03). There was significant heterogeneity found in the outcome with significant chi-square tests and I2 statistics > 75%.Conclusion: Findings from our review demonstrate promise in the applicability of ultrasonography as a major diagnostic tool for confirming the endotracheal tube intubation.

Unexpected Lung Collapse Following Chest Tube Insertion for Pneumothorax Drainage in an Intubated Patient Due to Dislocation of the Endotracheal Tube

“…The tube must be adjusted according to the patient's dimensions and carefully secured at the proper distance at the incisors. Additional checks that are essential by the anesthetist to find out malplacement of an endotracheal tube include observation for symmetrical chest movements (rise and fall during positive pressure ventilation, indicating proper inflation of both lungs), colorimetric capnography (it measures the concentration of carbon dioxide in exhaled air), video laryngoscopy and fiberoptic bronchoscopy (direct visualization of the tube passing through the vocal cords), use of depth markers, and ultrasonography (used to visualize the trachea and confirm endotracheal tube placement, particularly in challenging cases or when other methods are inconclusive) [6][7][8]. Furthermore, the surgeon should consistently monitor the movements of the pleura on both sides, which are influenced by the inflation and deflation of the lungs following mid-sternotomy.…”

Regional anesthesia and POCUS in the intensive care unit

“…Several meta-analyses have demonstrated that ultrasound has high diagnostic value. [69][70][71][72][73] A 2018 meta-analysis of 17 studies found an overall 98.7% sensitivity, 97.1% specificity, a positive likelihood ratio of 34.4, and a negative likelihood ratio of 0.01. Importantly, "subgroup analyses did not demonstrate a significant difference by location, provider specialty, provider experience, transducer type, or technique".…”

“…The question remains, how reliable is ultrasound to detect successful versus unsuccessful endotracheal intubation? Several meta-analyses have demonstrated that ultrasound has high diagnostic value 69–73 . A 2018 meta-analysis of 17 studies found an overall 98.7% sensitivity, 97.1% specificity, a positive likelihood ratio of 34.4, and a negative likelihood ratio of 0.01.…”