Confirmation of endotracheal intubation by combined ultrasonographic methods in the Emergency Department.
OBJECTIVE
The objective of the present study was to investigate whether the combined use of transcricothyroid membrane ultrasonography and ultrasonographic evaluation for pleural sliding is useful for verifying endotracheal intubation in the ED.


METHODS
We performed a prospective clinical trial in the ED from January to July 2008. All patients enrolled in the present study had been admitted to the ED owing to severe airway problems. A linear probe was placed horizontally over the cricothyroid membrane (dynamic phase) during the intubation process. Endotracheal intubation was confirmed by ultrasonographic lung sliding. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated.


RESULTS
Thirty patients (17 men, 13 women; mean age 59.6 +/- 16.7 [SD] years) were enrolled in the study. Of the 30, 7 had a history of trauma. Four trauma patients were diagnosed with haemopneumothorax. The ratio of initial oesophageal-to-endotracheal intubation was 3:27. Sensitivity, specificity, PPV and NPV for endotracheal intubation were 96.3%, 100%, 100% and 75%, respectively. After verification by ultrasonographic lung sliding, sensitivity, specificity, PPV and NPV were each 100%.


CONCLUSIONS
The combination of transcricothyroid membrane ultrasonography and ultrasonographic lung-sliding evaluation could be useful in confirming endotracheal intubation in the ED.
Park
Soon Chang
SC
Department of Emergency Medicine, Pusan National University Hospital, Busan, South Korea.
Ryu
Ji Ho
JH
Yeom
Seok Ran
SR
Jeong
Jin Woo
JW
Cho
Suck Ju
SJ
D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D007830:Larynx / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014132:Trachea / Q000000981:diagnostic imaging; D018084:Ultrasonography, Interventional / Q000379:methods*