Research & Innovation in Anesthesia

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VOLUME 7 , ISSUE 1 ( January-June, 2022 ) > List of Articles

Original Article

Confirmation of Endotracheal Tube Placement in Trachea Ultrasonography vs End-tidal Capnography with Auscultation: An Observational Study

Sanjog Mekewar, Pritee H Bhirud, Shrividya Chellam, Pratibha V Toal, Prachee Gawade

Keywords : Airway, Endotracheal tube, Trachea, USG

Citation Information : Mekewar S, Bhirud PH, Chellam S, Toal PV, Gawade P. Confirmation of Endotracheal Tube Placement in Trachea Ultrasonography vs End-tidal Capnography with Auscultation: An Observational Study. Res Inno Anesth 2022; 7 (1):5-9.

DOI: 10.5005/jp-journals-10049-2006

License: CC BY-NC 4.0

Published Online: 30-03-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background and aim: Early detection of complications after intubation is necessary as outcomes can be fatal. In search of an ideal test, we conducted this study under ideal settings to compare the time required and efficacy of airway ultrasonography (USG) vs Capnography with auscultation to confirm correct placement of endotracheal tube after intubation. Methodology: In this prospective, randomized, comparative study, we randomly allocated our sample population of 130 posted for general anesthesia in elective cases in operation theater into two groups and then used capnography with auscultation for group A and USG for group B to confirm tube placement in the trachea. We compared the efficacy and time taken by the two methods of confirmation. p value < 0.05 was considered statistically significant. Results: Tracheal USG confirmation time in group B (2.8 ± 1.9 s) was significantly lower than capnography confirmation time in group A (7.5 ± 2.4 s) (p = 0.03). Time taken to confirm bilaterally equal air entry by auscultation in group A and USG sliding lung sign in group B were comparable. Total time taken for confirmation with USG (16.87 ± 8 s) was faster than auscultation and capnography (24.7 ± 10.6 s) but was not statistically significant (p = 0.43). Both the methods were comparable with respect to efficacy. Conclusion: We conclude that USG is a faster modality for confirmation of correct placement of endotracheal tube compared to capnography and auscultation. Both methods are compared with respect to efficacy.

  1. Divatia J V, Bhowmick K. Complications of ETI and other airway management procedures. Airw Manag Indian J Anaesth Crit Care 2005;49(2):308–318.
  2. Kodali BS. Capnography outside the operating rooms. Anesthesiology 2013;118(1):192–201. DOI: 10.1097/ALN.0b013e318278c8b6
  3. Grmec S. Comparison of three different methods to confirm tracheal tube placement in emergency intubation. Intensive Care Med 2002;28(6):701–704. DOI: 10.1007/s00134-002-1290-x
  4. Reddy DA, Reddy IRK, Bindu DH. Ultrasonography for endotracheal tube placement confirmation in an emergency setting– a prospective study in a Teritiary Hospital. Int J Med Sci Clin Invent 2018;5(2):3545–3549. DOI: 10.18535/ijmsci/v5i2.11
  5. Karacabey S, Sanri E, Gencer EG, et al. Tracheal ultrasonography and ultrasonographic lung sliding for confirming ETTplacement: speed and reliability. Am J Emerg Med 2016;34(6):953–956. DOI: 10.1016/j.ajem.2016.01.027
  6. Zadel S, Strnad M, Prosen G, et al. Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation 2015;87:1–6. DOI: 10.1016/j.resuscitation.2014.11.006
  7. Chou HC, Chong KM, Sim SS, et al. Real-time tracheal ultrasonography for confirmation of ETTplacement during cardiopulmonary resuscitation. Resuscitation 2013;84(12):1708–1712. DOI: 10.1016/j.resuscitation.2013.06.018
  8. Chenkin J, McCartney CJL, Jelic T, et al. Defining the learning curve of point-of-care ultrasound for confirming ETTplacement by emergency physicians. Crit Ultrasound J 2015;7(1):14. DOI: 10.1186/s13089-015-0031-7
  9. McCormick TJ, Miller EC, Chen R, et al. Acquiring and maintaining point-of-care ultrasound (POCUS) competence for anesthesiologists. Can J Anesth 2018;65(4):427–436. DOI: 10.1007/s12630-018-1049-7
  10. Kundra P, Mishra SK, Ramesh A. Ultrasound of the airway. Indian J Anaesth 2011;55(5):456–462. DOI: 10.4103/0019-5049.89868
  11. Piette E, Daoust R, Lambert J, et al. Lung sliding identification is less accurate in the left hemithorax. J Ultrasound Med 2017;36(2):327–333. DOI: 10.7863/ultra.15.06092
  12. Weaver B, Lyon M, Blaivas M. Confirmation of ETTplacement after intubation using the ultrasound sliding lung sign. Acad Emerg Med 2006;13(3):239–244. DOI: 10.1197/j.aem.2005.08.014
  13. Parab SY, Divatia J V, Chogle A. A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries. Indian J Anaesth 2015;59(8):476–481. DOI: 10.4103/0019-5049.162983
  14. Abhishek C, Munta K, Rao S M, et al. End-tidal capnography and upper airway ultrasonography in the rapid confirmation of endotracheal tube placement in patients requiring intubation for general anaesthesia. Indian J Anaesth 2017;61(6):486–489. DOI: 10.4103/ija.IJA_544_16
  15. Bache S, Pfeiffer P, Rudolph SS, et al. Temporal comparison of ultrasound versus auscultation and capnography in verification of ETTPlacement. Acta Anaesthesiol Scand 2011;55:1190–1195. DOI: 10.1111/j.1399-6576.2011.02501.x
  16. Adi O, Chuan TW, Manikam R. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying ETTlocation after intubation. Crit Ultrasound J 2013;5(1):7. DOI: 10.1186/2036-7902-5-7
  17. Sim SS, Lien WC, Chou HC, et al. Ultrasonographic lung sliding sign in confirming proper ETI during emergency intubation. Resuscitation 2012;83(3):307–312. DOI: 10.1016/j.resuscitation.2011.11.010
  18. Rajan S, Surendran J, Paul J, et al. Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming ETI in overweight and obese patients. Indian J Anaesth 2017;61(3):230–234. DOI: 10.4103/0019-5049.202164
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