ULTRASOUND AS A TOOL FOR ENDOTRACHEAL TUBE CONFIRMATION IN PATIENTS WITH OR WITHOUT DIFFICULT AIRWAY UNDERGOING ELECTIVE SURGERY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 39
Abstract
BACKGROUND Aims- Ultrasound is underutilised but effective tool for airway evaluation and management in emergency and elective conditions. In this study, primary aim was to compare the confirmation time for endotracheal intubation by USG versus waveform capnography in patients with MPG I - IV. Secondary aim was to calculate sensitivity, specificity and accuracy of using ultrasound for confirmation of endotracheal tube placement. MATERIALS AND METHODS A prospective, single centre, observational study was carried out in patients undergoing elective surgery and requiring endotracheal intubation. A total of 50 patients from each MPG were recruited making a total of 200. During intubation, real time transtracheal ultrasonography was performed to visualise the passage of endotracheal tube. Bag ventilation was started, capnography with end tidal CO2 levels was observed by other faculty and simultaneous auscultation of chest and epigastrium was done. Bilateral lung USG was done for detection of lung sliding as an indicator of bilateral lung ventilation, which was finally confirmed by subxiphoid view, which showed diaphragmatic movement. RESULTS 1. USG was better than waveform capnography in terms of confirmation time in all 4 groups (p < 0.001). 2. Transtracheal ultrasonography had 96% accuracy for confirmation of endotracheal intubation. 3. Overall sensitivity was 100% and specificity of MP I - III was more than 80%. 4. Overall specificity of MPG IV was 25%, but on subgroup analysis into patients with or without distorted neck anatomy, specificity was more than 80% in patients with normal neck anatomy. CONCLUSION Ultrasound is a rapid and accurate tool for confirmation of endotracheal tube placement in patients with or without difficult airway undergoing elective surgery but visualisation of trachea is difficult in cases with distorted neck anatomy.
Authors and Affiliations
Nidhi Rani Gupta, Deepa George, Letha J. Babukutty, Vimal Pradeep
Keywords
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- EP ID EP213037
- DOI 10.14260/Jemds/2017/673
- Views 83
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