Point-of-care ultrasound versus auscultation in determining the position of double-lumen tube

Abstract

This study was designed to assess the accuracy of point-of-care ultrasound in determining the position of double-lumen tubes (DLTs).A total of 103 patients who required DLT intubation were enrolled into the study. After DLTs were tracheal intubated in the supine position, an auscultation researcher and ultrasound researcher were sequentially invited in the operating room to conduct their evaluation of the DLT. After the end of their evaluation, fiberscope researchers (FRs) were invited in the operating room to evaluate the position of DLT using a fiberscope. After the patients were changed to the lateral position, the same evaluation process was repeated. These 3 researchers were blind to each other when they made their conclusions. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained by statistical analysis.When left DLTs (LDLTs) were used, the accuracy of ultrasound (84.2% [72.1%, 92.5%]) was higher than the accuracy of auscultation (59.7% [45.8%, 72.4%]) (P < .01). When right DLTs (RDLTs) were used, the accuracy of ultrasound (89.1% [76.4%, 96.4%]) was higher than the accuracy of auscultation (67.4% [52.0%, 80.5%]) (P < .01). When LDLTs were used in the lateral position, the accuracy of ultrasound (75.4% [62.2%, 85.9%]) was higher than the accuracy of auscultation (54.4% [40.7%, 67.6%]) (P < .05). When RDLT were used, the accuracy of ultrasound (73.9% [58.9%, 85.7%]) was higher than the accuracy of auscultation (47.8% [32.9%, 63.1%]) (P < .05).Assessment via point-of-care ultrasound is superior to auscultation in determining the position of DLTs.

Point-of-care lung ultrasound to evaluate lung isolation during one-lung ventilation in children: A case report

“…POCUS showed statistically significant higher diagnostic accuracy than auscultation. [4] Despite this evidence from the adult population, there is only one anecdotal case report in the pediatric population. [6]…”

“…Although POCUS in all of the previously mentioned studies except one was performed in the supine position, we performed the study in both the supine and lateral decubitus positions. [4] As the position of the ETT may change after the patient is placed in the lateral decubitus position, a repeat study may be indicated once the patient is positioned. We were able to evaluate easily the nondependent lung by ultrasound after positioning.…”

“…The latter may be superior to auscultation in demonstrating effective lung separation. [45] However, there are limited data in children. We describe anecdotal experience with POCUS to guide OLV during robot-assisted thoracic surgery in a child.…”

<p>Point-of-Care Lung Ultrasound to Evaluate Lung Isolation During One-Lung Ventilation in Children: Narrative Review</p>

“…Many of the studies evaluating lung ultrasound were performed in patients who were scheduled for elective surgery with limited intrinsic lung disease. [3][4][5][6] Pulmonary parenchymal with consolidation or atelectasis may impede lung ultrasound as lung sliding is observed only in ventilated areas. Therefore, even if two-lung ventilation is performed, Figure 3 Bar code sign in an adult.…”

“…2 Similar results have been reported when using a double lumen endotracheal tube for OLV. [3][4][5][6] To date, there are a limited number of case reports regarding the use of lung ultrasound in children and no prospective clinical trials. There is increasing clinical use of point-of-care ultrasound (POCUS) to identify effective lung separation thereby eliminating the need for bronchoscopy and limiting inaccuracies with auscultation.…”