Point-of-care sonographic detection of left endobronchial main stem intubation and obstruction versus endotracheal intubation.
OBJECTIVE
Determining the correct position of endotracheal tubes in critically ill patients may be complicated by external factors such as noise, body habitus, and the need for ongoing resuscitation. Multiple detection techniques have been developed to determine the correct endotracheal tube position, recently including the use of sonography to evaluate lung expansion and diaphragmatic excursion. These techniques have also been applied to diagnosis of right endobronchial main stem intubation, which may be confused with a unilateral pneumothorax in some cases.


METHODS
We describe the sonographic findings in a case series of endobronchial main stem intubations and obstruction, highlighting the utility of this sonographic application. Previous literature and future applications are discussed.


RESULTS
Sonographic detection of the sliding lung sign, the lung pulse, and diaphragmatic excursion can accurately detect main stem bronchial intubation as well as bronchial obstruction.


CONCLUSIONS
Clinical use of lung sonography may decrease the need for chest radiography and may allow more rapid diagnosis of main stem intubation and bronchial obstruction.
Blaivas
Michael
M
Department of Emergency Medicine, Northside Hospital-Forsyth, Cumming, GA 30041, USA. blaivas@pyro.net
Tsung
James W
JW
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000402:Airway Obstruction / Q000000981:diagnostic imaging*; D001980:Bronchi / Q000000981:diagnostic imaging*; D003964:Diaphragm / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D011014:Pneumonia / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional