Confirmation of endotracheal intubation by combined ultrasonographic methods in the Emergency Department

Soon Chang Park, Ji Ho Ryu, Seok Ran Yeom, Jin Woo Jeong, Suck Ju Cho
Emergency Medicine Australasia: EMA 2009, 21 (4): 293-7

OBJECTIVES: The objective of the present study was to investigate whether the combined use of transcricothyroid membrane ultrasonography and ultrasonographic evaluation for pleural sliding is useful for verifying endotracheal intubation in the ED.

METHODS: We performed a prospective clinical trial in the ED from January to July 2008. All patients enrolled in the present study had been admitted to the ED owing to severe airway problems. A linear probe was placed horizontally over the cricothyroid membrane (dynamic phase) during the intubation process. Endotracheal intubation was confirmed by ultrasonographic lung sliding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.

RESULTS: Thirty patients (17 men, 13 women; mean age 59.6 +/- 16.7 [SD] years) were enrolled in the study. Of the 30, 7 had a history of trauma. Four trauma patients were diagnosed with haemopneumothorax. The ratio of initial oesophageal-to-endotracheal intubation was 3:27. Sensitivity, specificity, PPV and NPV for endotracheal intubation were 96.3%, 100%, 100% and 75%, respectively. After verification by ultrasonographic lung sliding, sensitivity, specificity, PPV and NPV were each 100%.

CONCLUSIONS: The combination of transcricothyroid membrane ultrasonography and ultrasonographic lung-sliding evaluation could be useful in confirming endotracheal intubation in the ED.

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