title: Secondary confirmation of endotracheal tube position by diaphragm motion in right subcostal ultrasound view.
abstract: OBJECTIVE
  To assess the sensitivity and specificity of right subcostal ultrasound view to confirm correct endotracheal tube intubation (ETT).
  
  
  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.
authors: Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors: Javad Seyed
authors: JS
authors: Hosseini
authors: Mohammad Taghi
authors: MT
authors: Talebian
authors: Mohammad Hassan
authors: MH
authors: Ghafari
authors: Vahid
authors: V
authors: Eslami
keywords: Diaphragm motion; endotracheal tube intubation; ultrasound
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