title: Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting.
abstract: OBJECTIVE
  The percentage of unrecognised orotracheal tube displacement in an out-of-hospital setting has been reported to be between 4.8% and 25%. The aim of our study was to assess the sensitivity and specificity of Point-of-Care-UltraSound (POCUS) for confirming the proper tube position after an urgent orotracheal intubation in an out-of-hospital setting and the time needed for POCUS.
  
  
  METHODS
  Our single-centred prospective study included all patients who needed out-of-hospital orotracheal intubation. After the intubation, bilateral chest auscultation and assessment of bilateral lung sliding and diaphragm excursion within POCUS were done. Spectrographic quantitative capnography was used as the reference standard to confirm a proper tube position.
  
  
  RESULTS
  We enrolled 124 patients. For auscultation, sensitivity and negative predicted value were 100%, specificity was 90% and positive predicted value 30% (95% confidence interval). Sensitivity, specificity, positive predicted value, and negative predicted value for POCUS alone and for a combination of auscultation and POCUS were 100% (95% confidence interval). In three patients, we detected endobronchial tube displacement with auscultation and POCUS. Capnography failed to detect displacement in all three cases. The median time needed for POCUS was 30s.
  
  
  CONCLUSIONS
  Results of our study support POCUS as an accurate and reliable method for confirming the proper orotracheal tube placement in trachea and it is feasible for out-of-hospital setting implementation. POCUS also seems to be time saving method but to make definitive conclusion more studies should be done.
authors.affiliation: Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia.
authors.forename: Sabina
authors.initials: S
authors.lastname: Zadel
authors.affiliation: Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia; Department of Emergency Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia.
authors.forename: Matej
authors.initials: M
authors.lastname: Strnad
authors.affiliation: Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia; Department of Physiology, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia; Department of Emergency Medicine, Faculty of Health Sciences, University of Maribor, Žitna 15, 2000 Maribor, Slovenia.
authors.forename: Gregor
authors.initials: G
authors.lastname: Prosen
authors.affiliation: Department of Emergency Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia; Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia. Electronic address: dusan.mekis@ukc-mb.si.
authors.forename: Dušan
authors.initials: D
authors.lastname: Mekiš
mesh_terms: D000328:Adult; D000368:Aged; D001314:Auscultation / Q000379:methods; D019296:Capnography / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D000067716:Point-of-Care Testing / Q000592:standards*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012015:Reference Standards; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*
keywords: Airway management; Capnography; Orotracheal intubation; Out-of-hospital setting; Point-of-Care-Ultrasound; Prehospital setting