Diagnostic Accuracy of Ultrasound for Confirmation of Endotracheal Tube Placement

Abstract

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

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

“…Based on the literature available till date, it is possible to recommend ultrasonography as even the first line tool for confirmation of endotracheal tube intubation compared to gold standard techniques such as end-tidal capnography, colorimetric capnography, fibreoptic bronchoscopy, direct visualization. Previous meta-analysis assessing the accuracy of ultrasonography revealed similar accuracy parameters compared to our review [48][49][50][51][52]. This shows that ultrasonography has a high amount of applicability in the clinical practice, as it has excellent performance with a very high specificity.…”

Using a bedside ultrasound (US), an emerging technology, to confirm endotracheal tube (ETT) location in adults in emergency department

“…Thus, its sensitivity and specificity vary based on operator experience and level of training. As there are studies with lesser sensitivity and specificity than our study as shown by Long et al 9 and Gottlieb et al 3 In this study adult patients were involved whose mean age was 49.6 years similar to that of study done by Abbasi, et al Majority of patients in our study were male (60.6%) similar to the study done by Chou et al 12 but was in contrast to study done by Chowdhury et al 13 The reason for this sex difference could be doctor from anesthesia department conducting study in elective patients undergoing surgery. Forty-five patients (66.2%) had bilateral equal air entry on auscultation, 14 (20.6%) had decrease air entry on left side of chest and 9 (13.2%) had decrease air entry on right side of chest during auscultation respectively.…”

“…8 Static, grayscale imaging are common methods to visualize the location of the ETT after placement. 9 Most of the studies are done in cadavers which mimic the live scenarios. 8 Studies that are done in live patients are conducted in controlled environment like preoperative settings.…”

Point-of-care ultrasound for airway management in the emergency and critical care setting

“…In contrast, POCUS can allow rapid confirmation during or after the intubation attempt with a relatively short training period [10,40]. Among adults, POCUS is 99% sensitive and 97% specific [10,41]; whereas, POCUS is 92% to 100% sensitive and 100% specific in pediatric patients [42]. Studies have reported consistent accuracy regardless of the ETT size or type of transducer (e.g., linear, curvilinear) used [43,44].…”