SAN DIEGO – Assessment of the trachea and pleura via point-of-care ultrasound is superior to auscultation in determining the exact location of the endotracheal tube, a randomized, single-center study found.
“It’s been reported that about 20% of the time the endotracheal tube is malpositioned,” study author Dr. Davinder S. Ramsingh said in an interview at the annual meeting of the American Society of Anesthesiologists. “Most of the time (the tube) is too deep, which can lead to severe complications.”
Dr. Davinder S. Ramsingh
In a double-blinded, randomized study, Dr. Ramsingh and his associates assessed the accuracy of auscultation vs. point-of-care ultrasound in verifying the correct position of the endotracheal tube (ETT). They enrolled 42 adults who required general anesthesia with ETT and randomized them to right main bronchus, left main bronchus, or tracheal intubation, followed by fiber optically–guided visualization to place the ETT. Next, an anesthesiologist blinded to the ETT exact location used auscultation to assess the location of the ETT, while another anesthesiologist blinded to the ETT exact location used point-of-care ultrasound to assess the location of the ETT. The ultrasound exam consisted of assessing tracheal dilation via standard cuff inflation with air and evaluation of pleural lung sliding, explained Dr. Ramsingh of the department of anesthesiology and perioperative care at the University of California, Irvine.
Dr. Ramsingh reported that in differentiating tracheal versus bronchial intubations, auscultation demonstrated a sensitivity of 66% and a specificity of 59%, while ultrasound demonstrated a sensitivity of 93% and a specificity of 96%. Chi-square comparison showed a statistically significant improvement with ultrasound (P = .0005), while inter-observer agreement of the ultrasound findings was 100%.
Limitations of the study, he said, include the fact that “we don’t know the incidence of malpositioned endotracheal tubes in the operating room and that this study was evaluating patients undergoing elective surgical procedures.”
The researchers reported having no financial disclosures.