The diagnostic accuracy of an inclusive three-window ultrasonography assessment for the rapid authentication of endotracheal tube position in RICU

Abstract

BackgroundAssurance of proper endotracheal tube (ETT) location is crucial immediately after intubation as undiagnosed esophageal intubation can be catastrophic. The primary purpose for this study is to determine the diagnostic accuracy of to evaluate the accuracy of an inclusive three-window ultrasonography assessment for the rapid authentication of endotracheal tube position in the intensive care unit (RICU) with reference to Co2 monitors (capnography) (the gold standard technique), The study included 100 patients who needed emergency intubation in the ICU of Aswan university hospital. Upon entrance to ICU, intubations was done by the residents and collective bedside three-windows ultra-sonography (tracheal, lung, diaphragmatic ultra-sonography) was carried out instantly after intubation Subsequently, the correct position of the endotracheal tube was established by the resident investigator via the use a capnometer.ResultsWaveform capnography revealed endotracheal intubation in 80 cases (80%) and esophageal intubation in 20 cases (20%). However, trans-tracheal ultra-sonography (TUS) was able to detect endotracheal intubation in 78 cases (78%) and esophageal intubation in 22 cases (22%) patients. SLS detected only 17 esophageal intubations from 20 cases detected by CO2 detectors. DUS was able to detect proper endotracheal intubation in 77 cases (77%) and esophageal intubation in 23 cases (23%). However, it detected only 17 esophageal intubations from 20 cases detected by Co2 detectors.ConclusionsUltra-sonography, as recently introduced practice for validation of correct endotracheal tube location has both high accuracy and safety profile and can be used as a primary authentication technique.Trial registrationNCT05747248