title: Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography.
abstract: BACKGROUND
  Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for verifying endotracheal intubation in obese patients.
  
  
  METHODS
  A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography.
  
  
  RESULTS
  Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P < 0.0001.
  
  
  CONCLUSIONS
  In obese patients, verification of endotracheal tube placement with US is as fast as auscultation alone and faster than the standard method of auscultation and capnography.
authors.affiliation: Akutcentrum/Anestesikliniken, Skåne University Hospital, SUS Malmø, Sweden. peter.pfeiffer@skane.se
authors.forename: P
authors.initials: P
authors.lastname: Pfeiffer
authors.forename: S
authors.initials: S
authors.lastname: Bache
authors.forename: D L
authors.initials: DL
authors.lastname: Isbye
authors.forename: S S
authors.initials: SS
authors.lastname: Rudolph
authors.forename: L
authors.initials: L
authors.lastname: Rovsing
authors.forename: J
authors.initials: J
authors.lastname: Børglum
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001314:Auscultation / Q000379:methods*; D050110:Bariatric Surgery; D019296:Capnography / Q000379:methods*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D009719:Nurse Anesthetists; D009765:Obesity / Q000150:complications* / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D018401:Sample Size; D016896:Treatment Outcome; D014463:Ultrasonography