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Where's the Tube? Evaluation of Hand-heldUltrasound in Confirming Endotracheal TubePlacement

Published online by Cambridge University Press:  28 June 2012

Rosaleen Chun ,
Andrew W. Kirkpatrick ,
M. Sirois ,
A.E. Sargasyn ,
S. Melton ,
D.R. Hamilton  and
S. Dulchavsky
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Abstract

Introduction:

The diagnosis of endotracheal tube (ETT)mal-position may be delayed in extremeenvironments. Several methods are utilized toconfirm proper ETT placement, but these methodscan be unreliable or unavailable in certainsettings. Thoracic sonography, previously utilizedto detect pneumothoraces, has not been tested toassess ETT placement.

Hypothesis:

Thoracic sonography could correlate withpulmonary ventilation, and thereby, help toconfirm proper ETT placement.

Methods:

Thirteen patients requiring elective intubationunder general anesthesia, and data from two traumapatients were evaluated. Using a portable,hand-held, ultrasound (PHHU) machine, sonographicrecordings of the chest wall visceral-parietalpleural interface (VPPI) were recorded bilaterallyin each patient during all phases of airwaymanagement: (1) preoxygenation; (2) induction; (3)paralysis; (4) intubation; and (5) ventilation.Results: The VPPI could be well-imaged for all ofthe patients. In the two trauma patients, rightmainstem intubations were noted in which specificpleural signals were not seen in the left chestwall VPPI after tube placement. These signsreturned after correct repositioning of the ETTtube. In all of the elective surgery patients,signs correlating with bilateral ventilation ineach patient were imaged and correlated withconfirmation of ETT placement byanesthesiology.

Conclusions:

This report raises the possibility that thoracicsonography may be another tool that could be usedto confirm proper ETT placement. This techniquemay have merit in extreme environments, such as inremote, prehospital settings or during aerospacemedical transports, in which auscultation isimpossible due to noise, or capnography is notavailable, and thus, requires further scientificevaluation.

Keywords

endotracheal tube placementportablehand-held ultrasoundpulmonary ventilationresuscitationthoracic ultrasound

Information

Type
Brief Report
Information
Prehospital and Disaster Medicine , Volume 19 , Issue 4 , December 2004 , pp. 366 - 369
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2004

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