Real‐time Tracheal Ultrasound for the Confirmation of Endotracheal Intubations in the Intensive Care Unit: An Observational Study

Arya, Rohan; Schrift, David; Choe, Carol; Al-Jaghbeer, Mohammed

doi:10.1002/jum.14723

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…The results of the current study indicate that bedside real-time tracheal ultrasonography can effectively identify endotracheal intubation and esophageal intubation with an accuracy of 97.2% and has good consistency with fiberoptic bronchoscopy (kappa value of 0.844). These findings are consistent with the results reported by Arya et al 21 Moreover, bedside real-time tracheal ultrasonography also shortens the time needed for determining the ETT position. Tracheal ultrasonography can identify esophageal intubation by revealing esophageal dilatation and the double-track sign produced by the adjacent trachea.…”

Section: Discussionsupporting

confidence: 93%

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Chen

Wang

et al. 2019

J Int Med Res

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Objective Critically ill patients often require emergency endotracheal intubation and mechanical ventilation. When esophageal intubation is not confirmed early, treatment may be delayed, even for life-threatening conditions. We examined the accuracy of bedside real-time airway ultrasonography in confirming the endotracheal tube (ETT) position during emergency endotracheal intubation in patients in the intensive care unit (ICU). Methods This single-center prospective observational study included 118 patients who underwent urgent endotracheal intubation in the ICU of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine. Tracheal ultrasonography was used to confirm the ETT position during endotracheal intubation, after which fiberoptic bronchoscopy was performed. The accuracy of bedside real-time tracheal ultrasonography in determining the ETT position was examined. Results Twelve (10.2%) patients underwent endotracheal intubation. The kappa value was 0.844, indicating perfect consistency between tracheal ultrasonography and fiberoptic bronchoscopy in identifying esophageal intubation. The sensitivity, specificity, and positive and negative predictive values of tracheal ultrasonography in determining the ETT position were 75.0%, 100%, 100%, and 97.2%, respectively. Conclusions Bedside real-time tracheal ultrasonography accurately assesses the ETT position in the ICU and can identify the ETT position during intubation. These findings have important clinical applications and are of great significance for treatment of ICU patients.

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Section: Discussionsupporting

confidence: 93%

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Chen

Wang

et al. 2019

J Int Med Res

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“…Whereas elective intubation in the operating room is an extremely safe procedure, emergent intubation occurring out of the operating room has been shown to be a significantly vulnerable time for patients with a high association of complications [16][17][18] .…”

Section: Discussionmentioning

confidence: 99%

External Validation Of A Novel Signature Of Illness In Continuous Cardiorespiratory Monitoring To Detect Early Respiratory Deterioration Of ICU Patients

Tsai

et al. 2021

Preprint

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The goal of predictive analytics monitoring is the early detection of patients at high risk of subacute potentially catastrophic illnesses. A good example of a target illness is respiratory failure leading to urgent unplanned intubation, where early detection might lead to interventions that improve patient outcome. Previously, we identified signatures of this illness in the continuous cardiorespiratory monitoring data of Intensive Care Unit patients and devised algorithms to identify patients at rising risk. Here, we externally validated 3 logistic regression models to estimate risk of emergency intubation that were developed in Medical and Surgical ICUs at the University of Virginia. We calculated the model outputs for more than 8000 patients in University of California San Francisco ICUs, 240 of whom underwent emergency intubation as determined by individual chart review. We found that the AUC of the models exceeded 0.75 in this external population, and that the risk rose appreciably over the 12 hours prior to the event. We conclude that abnormal signatures of respiratory failure in the continuous cardiorespiratory monitoring are a generalizable phenomenon.

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“…[41][42][43] Using POCUS to confirm endotracheal tube placement has been shown to be highly accurate in numerous studies. [44][45][46][47][48][49][50] Additionally, location of the endotracheal tube tip can be ascertained without the use of a chest radiograph. 51 Combining POCUS with these methods is an attractive option to confirm endotracheal tube placement to minimize transmission risk inherent in obtaining a chest radiograph.…”

Section: The Intubation Scanmentioning

confidence: 99%

“…First, the intubation process is a high-transmission risk event and the scan requires a second non-intubating physician to be in the room. 45 To minimize transmission risk, guidelines recommend having a minimal number of team members participate in the procedure. 38,39,[52][53][54][55] Second, the peri-intubation period is often a high-value time to obtain a chest radiograph.…”

Section: The Intubation Scanmentioning

confidence: 99%

The Use of POCUS to Manage ICU Patients With COVID‐19

Schrift

Barron

Arya

et al. 2020

J of Ultrasound Medicine

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Since the advent of SARS-CoV-2, the virus that causes COVID-19, clinicians have had to modify how they provide high-value care while mitigating the risk of viral spread. Routine imaging studies have been discouraged due to elevated transmission risk. Patients who have been diagnosed with COVID-19 often have a protracted hospital course with progression of disease. Given the need for close follow-up of patients, we recommend the use of ultrasonography, particularly point-of-care ultrasound (POCUS), to manage patients with COVID-19 through their entire ICU course. POCUS will allow a clinician to evaluate and monitor cardiac and pulmonary function, as well as evaluate for thromboembolic disease, place an endotracheal tube, confirm central venous catheter placement, and rule out a pneumothorax. If a patient improves sufficiently to perform weaning trials, POCUS can also help evaluate readiness for ventilator liberation.

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Real‐time Tracheal Ultrasound for the Confirmation of Endotracheal Intubations in the Intensive Care Unit: An Observational Study

Cited by 11 publications

References 26 publications

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

External Validation Of A Novel Signature Of Illness In Continuous Cardiorespiratory Monitoring To Detect Early Respiratory Deterioration Of ICU Patients

The Use of POCUS to Manage ICU Patients With COVID‐19

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