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A Comparative Study to Confirm the Endotracheal Tube Placement Using Ultrasonography and Standard Auscultation Method
Neha Sinha1, Nandita Kad2, Mayuri Golhar2
1Department of Cardiac Anaesthesia, Pandit Bhagwat Dayal Sharma PGIMS, Rohtak, India.
Insights
Ultrasound-guided lung sliding is a reliable method for confirming endotracheal tube (ETT) position in children, offering higher accuracy than auscultation alone. This technique is essential for preventing serious complications in pediatric patients.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Critical Care Medicine
Background:
- Pediatric patients have a higher risk of endotracheal tube (ETT) malposition due to shorter tracheas, leading to serious complications.
- Standard auscultation for confirming ETT placement has limitations in accuracy.
- Ultrasound-guided lung sliding presents a potential alternative for verifying ETT position.
Purpose of the Study:
- To compare the accuracy and efficiency of standard auscultation and ultrasound-guided lung sliding for confirming endotracheal tube (ETT) position in pediatric patients.
- To evaluate diagnostic accuracy and time taken for confirmation using both methods against waveform capnography.
- To determine the reliability of ultrasound-guided lung sliding as a diagnostic tool in pediatric intubation.
Main Methods:
- A study involving 75 pediatric patients (2-8 years old, ASA I-II) undergoing general anesthesia with endotracheal intubation.
- ETT position was assessed using bilateral chest auscultation and ultrasound for lung-sliding signs.
- Findings were compared with waveform capnography to determine sensitivity, specificity, accuracy, and time for diagnosis.
Main Results:
- Ultrasound demonstrated a sensitivity of 94.31%, specificity of 72.33%, and accuracy of 90.7% compared to capnography.
- Standard auscultation showed lower accuracy with 82.8% sensitivity, 47.28% specificity, and 74.67% accuracy.
- Waveform capnography was fastest (10.29s), followed by auscultation (12.96s), and ultrasonography (14.28s) for confirmation.
Conclusions:
- Standard auscultation alone yields high false-negative results, making confirmation with ultrasound or capnography essential.
- Ultrasound-guided lung sliding is a simple, fast, and reliable method for detecting endotracheal tube malposition in children.
- Both ultrasound and waveform capnography are superior to auscultation for accurate ETT placement confirmation in pediatric patients.
Background:
In pediatric patients due to shorter trachea suboptimal positioning of endotracheal tube (ETT) is seen in 20%-50% of patients triggering grave complications. We compared standard auscultation and ultrasound-guided lung sliding to confirm the position of ETT in children.
Methods:
Seventy-five pediatric patients between 2-8 years of age, American Society of Anesthesiologists physical status classification I and II scheduled for surgery under general anesthesia with endotracheal intubation were studied. The position of ETT was confirmed by chest auscultation for the breath sounds bilaterally and by ultrasound on the same sites for lung-sliding signs. The data obtained were compared to findings on waveform capnography. Study outcomes included position of the ETT; tracheal or esophageal, accuracy of diagnosis and time taken till confirming the diagnosis.
Results:
Compared to waveform capnography findings, an ultrasound revealed a sensitivity of 94.31%, a specificity of 72.33%, and an accuracy of 90.7% while that for standard auscultation were 82.8%, 47.28%, and 74.67%, respectively. The mean time taken for confirmation of ETT position was significantly shorter with waveform capnography (10.29 ± 2.25 s) compared to auscultation (12.96 ± 2.23 s) and ultrasonography (USG) (14.28 ± 3.77 s).
Conclusion:
Confirmation of ETT position using USG or waveform capnography is essential because of high false results using standard auscultation alone. Ultrasound-guided lung sliding method is a simple, fast, and a reliable method used for detecting tube malposition.
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