Pars Journal of Medical Sciences

Comparison of intra-endotracheal real-time ultrasound method with other conventional methods in for confirming the location of endotracheal tube

Document Type : Original Article

Authors

1 Assistant Professor of Emergency Medicine, Shahroud University of Medical Sciences, Shahroud, Iran

2 Medical Student, Student research committee, Mashhad University of Medical sciences, Mashhad, Iran

3 Assistant professor, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.

4 Associated professor, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran.

5 Assistant Professor of Community Medicine, Department Community Medicine, School of Medicine, Mashhad University of Medical sciences, Mashhad, Iran

6 Assistant professor, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran

7 Associated professor, Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical sciences, Mashhad, Iran

Abstract

Introduction: The purpose of this study is to compare the accuracy of the real-time ultrasound method in determining
the correct location of intubation, compared to conventional methods, in the patients of the emergency
department of Imam Rezai Hospital in Mashhad.
Methods & Materials: This is a descriptive-analytic prospective study to determine the diagnostic value of real-time ultrasound for the accuracy of intubation. The standard test to determine the correct intubation is lung auscultation
findings, checking ventilator curves and, if observed, passing the tracheal tube through the vocal cords. Data analysis was done to calculate sensitivity, specificity, positive and negative news value. A positive test was considered as passing the endotracheal tube into the esophagus (wrong tube placement).
Results: In this study, 52 patients were examined. Endotracheal intubation was confirmed by chest auscultation in 30 cases. By observing ventilator curves, confirmation of endotracheal intubation was confirmed in 26 cases. Observation of vocal cords was confirmed in 37 cases. Based on this, 26 patients had all three approval scales for endotracheal intubation. Ultrasound confirmed the correctness of intubation in 36 cases. Considering the gold standard as the positiveness of all three tests, and considering the fact that the tube does not pass through the trachea as the factor we are looking for, the sensitivity of endotracheal ultrasound is 96.15% and its specificity is 57.69%. Came. The values of PLR, NLR, PPV, NPV were 2.27, 0.07, 69.44% and 93.75%, respectively.
Conclusion: In short, tracheal ultrasound test has a higher specificity than sensitivity for detecting tracheal intubation
errors, which means that it is more effective in correctly identifying patients whose intubation errors did not occur than those who did. It is more reliable. However, the high rate of intubation errors in our study affects these results.

Keywords

  1. Neumar RW, Otto CW, Link MS, Kronick SL, Shuster M, Callaway CW, et al. Part 8: adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(3): 729–67.
  2. Jones JH, Murphy MP, Dickson RL, Somerville GG, Brizendine EJ. Emergency physician–verified out‐of‐hospital intubation: miss rates by paramedics. Acad Emerg Med. 2004;11(6):707–9.
  3. Holzki J, Brown KA, Carroll RG, Coté CJ. The anatomy of the pediatric airway: Has our knowledge changed in 120 years? A review of historic and recent investigations of the anatomy of the pediatric larynx. Ped Anesth. 2018;28(1):13–22.
  4. Travers AH, Rea TD, Bobrow BJ, Edelson DP, Berg RA, Sayre MR, et al. Part 4: CPR overview: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18_suppl_3):S676–84.
  5. Bailey CR. Time to stop using uncuffed tracheal tubes in children? Anaesthesia. 2018;73(2):147–50.
  6. de Wit M, Peelen LM, Van Wolfswinkel L, de Graaff JC. The incidence of postoperative respiratory complications: A retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0‐7 years of age. Ped Anesth. 2018;28(3):210–7.
  7. Chou H-C, Chong K-M, Sim S-S, Ma MH-M, Liu S-H, Chen N-C, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84(12):1708–12.
  8. Kundra P, Padala SRAN, Jha AK. Ultrasound guided tracheal intubation with a styleted tracheal tube in anticipated difficult airway. J Clin Monit Comput. 2021 Apr;35(2):285-287.
  9. Ahmadi K, Pishbin E, Ramezani M, Ebrahimi M. Ultrasound as a Secondary Confirmation Method after Endotracheal Intubation. Med J of Mashhad Uni of med sci, 2013; 56(4): 236-242.

10.Thomas VK, Paul C, Rajeev PC, Palatty BU. Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting. Indian journal of critical care medicine: peer-reviewed. Indian J Crit Care Med. 2017 May;21(5):257.

  1. Chowdhury AR, Punj J, Pandey R, Darlong V, Sinha R, Bhoi D. Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents-A prospective controlled clinical trial. Saudi J Anaesth. 2020 Jan;14(1):15.
  2. Kabil AE, Ewis AM, Al-Ashkar AM, Abdelatif MA, Nour MO. Real-time tracheal ultrasonography for confirming endotracheal tube placement. Egypt J Bronchol. 2018 Sep;12(3):323-8.

13.Karlijn J van Stralen, Vianda S Stel, Johannes B Reitsma, Friedo W. Dekker. Diagnostic methods I: Sensitivity, specificity, and other measures of accuracy. Kidney Int. 2009; 75, 1257–126

14.Senussi MH, Kantamneni PC, Latifi M, Omranian AP, Krveshi L, Barakat AF, Masri A, Schmidhofer M. Protocolized tracheal and thoracic ultrasound for confirmation of endotracheal intubation and positioning: a multicenter observational study. Crit Care Explor. 2020 Sep 1;2(9):e0225