Publications
Transtracheal ultrasonography versus end- tidal capnography in rapid confirmation of endotracheal tube placement
Shruthi Rioniz, Nischala Dixit, Preethi Rioniz, Thomas T Vellapally, Nayanthara Joachim, Siddhanth Suresh Background: Prompt confirmation of proper endotracheal (ET) tube placement
after intubation is imperative to averting life-threatening consequences. Waveform
capnography, although the gold standard method, poses some limitations while
transtracheal ultrasonography (USG) is a reliable real-time technique that has shown
much promise. Existing literature on the faster method has yielded conflicting results.
Aims and Objectives: This study aims to determine the mean time taken to confirm
the correct placement of the ET tube using both transtracheal USG and end-tidal
capnography. A comparative assessment of the faster method will supplement
patient care by helping anesthesiologists avoid accidental esophageal/endobronchial
intubation and the associated morbidity. Materials and Methods: Consenting adult
patients posted for elective surgeries under general anesthesia were recruited over
a period of 18 months. The time taken for confirmation of correct tube placement
by both transtracheal USG and capnographic end-tidal carbon dioxide tracing was
recorded. A paired samples t-test was used to compare the means (±standard
deviation). Results: The study included 112 patients aged 40.1±12 years of whom
59 (52.6%) were females. The mean time taken to confirm tube placement by USG
and capnography was 35.8±9.8 s and 67.4±13.7 s, respectively, with a mean time
difference of 31.6±7.8 s which was found to be statistically significant (P<0.001).
Conclusion: Transtracheal USG is the faster method to confirm the proper placement
of an ET tube during intubation when compared to waveform capnography. USG is
also beneficial in detecting and avoiding accidental esophageal intubations.
Key words: General anesthesia; Airway management; Intubation; Capnography;
Ultrasonography; Endotracheal tube
