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. 2013 Apr;3(2):113-7.
doi: 10.4103/2229-5151.114269.

Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view

Javad Seyed Hosseini  1 , Mohammad Taghi Talebian, Mohammad Hassan Ghafari, Vahid Eslami
Affiliations

Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view

Javad Seyed Hosseini et al. Int J Crit Illn Inj Sci. 2013 Apr.

Abstract

Aims: To assess the sensitivity and specificity of right subcostal ultrasound view to confirm correct endotracheal tube intubation (ETT).

Materials and methods: In this prospective study, apneic or paralyzed patients who had an indication of intubation were selected. Intubation and ventilation with bag were performed by the skilled third-year emergency medicine residents. The residents, following a brief training course of ultrasonography, interpreted the diaphragm motion, and identified either esophageal or tracheal intubation. The confirmation of ETT placement was done by the sonographer. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for tracheal versus esophageal intubation.

Results: A total of 57 patients aged 59 ± 5 who underwent ETT insertion were studied. Thirty-four of them were male (60%). Ultrasound correctly identified 11 out of 12 esophageal intubations for a sensitivity of 92% (95% CI = 62-100), but misidentified one esophageal intubation as tracheal. Sonographers correctly identified 43 out of 45 (96%) tracheal intubations for a specificity of 96% (95% CI = 85-99), but misdiagnosed two tracheal intubations as esophageal.

Conclusions: This study suggests that diaphragm motion in right subcostal ultrasound view is an effective adjunct to diagnose ETT place in patients undergoing intubation in emergency department.

Keywords: Diaphragm motion; endotracheal tube intubation; ultrasound.

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Conflict of interest statement

Conflict of Interest: No.

Figures

Figure 1
Figure 1
Position of the probe on the patient's abdomen
Figure 2
Figure 2
(a) Diaphragm view in the right subcostal area before ventilation. (b) right side diaphragm position during the positive-pressure ventilation
See this image and copyright information in PMC

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