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A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians
Author(s) -
Lahham Shadi,
Baydoun Jamie,
Bailey James,
Sandoval Sandra,
Wilson Sean P.,
Fox John C.,
Slattery David E.
Publication year - 2017
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.14231
Subject(s) - medicine , intubation , emergency department , endotracheal tube , confidence interval , airway , prospective cohort study , endotracheal intubation , airway management , emergency medicine , emergency physician , tracheal intubation , cohort study , anesthesia , surgery , psychiatry
Objectives Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real‐time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. Methods We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end‐tidal carbon dioxide detection results, performed real‐time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. Results Seventy‐two patients were enrolled in the study. Sixty‐eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false‐negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%–99.9%) and specificity of 75.0% (95% confidence interval, 19.4%–99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. Conclusions A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position.