Ultrasound as a Secondary Confirmation Method after Endotracheal Intubation

Document Type : Research Paper

Authors

1 Assistant Professor of Emergency Medicine, Alborz University of Medical Science, Karaj, Iran

2 Assistant Professor of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Resident of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction
Beside assessment by physical examination a device also should be used to confirm the correct position of endotracheal tube immediately after intubation. Recent studies have shown that ultrasound can be a used to detect diaphragmatic motion as an indirect sign of endotracheal intubation.
Our objective was to assess the sensitivity and specificity of ultrasound for verification of tube position after intubation and to evaluate whether ultrasound could be used as a usefull method for secondary confirmation of tube position.
Materials and Methods
Ultrasound imaging was performed immediately after intubation for each patient. Scanning window was in right lower chest where the right lateral part of diaphragm could be imaged just on top of the liver. Then a second laryngoscopy was performed by the means of a glydoscope and tube position was assessed under direct visualization. Sensitivity, specificity and agreement between 2 methods were calculated.
Results
Overall 100 patients with a mean age of 67.1 ± 16.6 [SD] years were included in the study. The sensitivity and specificity of ultrasound for correct tracheal intubation was 97% and 100% respectively. Agreement between ultrasound and glydoscope in assessment of tube position was 0.713 which indicated that there was an acceptable agreement between the 2 methods. We successfully identified all 4 esophageal intubations and 9 tracheal intubations which had been positioned down in to the right main bronchus.
Conclusion
Diaphragmatic ultrasound is a rapid, noninvasive and useful method for assessment of endotracheal tube position.

Keywords

medical journal of mashhad university of medical sciences
Volume 56, Issue 4 - Serial Number 4
September and October 2013
Pages 236-242

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