• Prehosp Disaster Med · Oct 2004

    Comparative Study

    Where's the tube? Evaluation of hand-held ultrasound in confirming endotracheal tube placement.

    • Rosaleen Chun, Andrew W Kirkpatrick, M Sirois, A E Sargasyn, S Melton, D R Hamilton, and S Dulchavsky.
    • Department of Anesthesia, Foothills Medical Centre, Calgary, Alberta, Canada.
    • Prehosp Disaster Med. 2004 Oct 1;19(4):366-9.

    IntroductionThe diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement.HypothesisThoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement.MethodsThirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) pre-oxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation.ResultsThe VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology.ConclusionsThis report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, pre-hospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.

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