Abstract
IntroductionGrayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years. The addition of color Doppler imaging (CDI) has been proposed to improve identification but has not been well studied. The aim of this study was to assess whether CDI improves correct localization of ETT placement.MethodsA convenience sample of emergency and critical care physicians at various levels of training and experience participated in an online assessment. Participants viewed US video clips of patients, which included either tracheal or esophageal intubations captured in grayscale or with CDI; there were five videos of each for a total of 20 videos. Participants were asked to watch each clip and then assess the location of the ETT.ResultsThirty-eight subjects participated in the online assessment. Levels of training included medical students (13%), emergency medicine (EM) residents (50%), EM attendings (32%), and critical care attendings (5%). The odds ratio of properly assessing tracheal placement using color relative to a grayscale imaging technique was 1.5 (p = 0.21). Regarding the correct assessment of esophageal placement, CDI had 1.4 times the odds of being correctly assessed relative to grayscale (p = 0.26). The relationship between training level and correct assessments was not significant for either tracheal or esophageal placements.ConclusionIn this pilot study we found no significant improvement in correct identification of ETT placement using color Doppler compared to grayscale ultrasound; however, there was a trend toward improvement that might be better elucidated in a larger study.
Highlights
Grayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years
The relationship between training level and correct assessments was not significant for either tracheal or esophageal placements. In this pilot study we found no significant improvement in correct identification of ETT placement using color Doppler compared to grayscale ultrasound; there was a trend toward improvement that might be better elucidated in a larger study. [West J Emerg Med. 2020;21(4)870-875.]
One prior investigation has compared the use of color Doppler imaging (CDI) with grayscale US for confirming ETT placement, and that study did not find a difference between the techniques in a cadaver model.[11]
Summary
Grayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years. The addition of color Doppler imaging (CDI) has been proposed to improve ETT localization by highlighting ETT movement, but this technique has not been well studied.[10,11] Only one prior investigation has compared the use of CDI with grayscale US for confirming ETT placement, and that study did not find a difference between the techniques in a cadaver model.[11] cadaver tissue often appears different from and lacks the respiratory variations of live human tissue with ultrasound imaging; a cadaver model may not accurately reflect the performance of CDI in confirming ETT placement in live humans.[12,13]
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