title: Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Early confirmation of endotracheal tube placement is of paramount importance to prevent hypoxia and its catastrophic consequences. Despite certain limitations, capnography is considered the gold standard to evaluate the proper placement of an endotracheal tube. Ultrasound is a novel tool with some definitive advantages over capnography. It enables a real-time view and can be performed quickly; furthermore, it is independent of pulmonary blood flow and does not require lung ventilation. In this review, we aimed to evaluate the diagnostic accuracy of transtracheal ultrasound in detecting endotracheal intubation.
  
  
  METHODS
  We completed an extensive search of MEDLINE®, EMBASE™, The Cochrane Library, KoreaMed, LILACS, OpenGrey, and the World Health Organization International Clinical Trials Registry from their inception to September 4, 2014. The studies that met the inclusion criteria were pooled and a meta-analysis was conducted.
  
  
  RESULTS
  Eleven studies and 969 intubations were included in the final analysis. Eight studies and 713 intubations were performed in emergency situations and the others were carried out in elective situations. Transtracheal ultrasonography's pooled sensitivity and specificity with 95% confidence intervals (CIs) were 0.98 (95% CI 0.97 to 0.99) and 0.98 (95% CI 0.95 to 0.99), respectively. In emergency scenarios, transtracheal ultrasonography showed an aggregate sensitivity and specificity of 0.98 (95% CI 0.97 to 0.99) and 0.94 (95% CI 0.86 to 0.98), respectively.
  
  
  CONCLUSIONS
  Transtracheal ultrasound is a useful tool to confirm endotracheal intubation with an acceptable degree of sensitivity and specificity. It can be used in emergency situations as a preliminary test before final confirmation by capnography.
authors.affiliation: Department of Anesthesia and Critical Care, Nazareth Hospital, Shillong, 793003, Meghalaya, India, drsauravdas1977@gmail.com.
authors.forename: Saurabh Kumar
authors.initials: SK
authors.lastname: Das
authors.forename: Nang Sujali
authors.initials: NS
authors.lastname: Choupoo
authors.forename: Rudrashish
authors.initials: R
authors.lastname: Haldar
authors.forename: Amitabh
authors.initials: A
authors.lastname: Lahkar
mesh_terms: D019296:Capnography / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D004630:Emergencies; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control; D007442:Intubation, Intratracheal / Q000379:methods*; D012680:Sensitivity and Specificity; D014132:Trachea / Q000000981:diagnostic imaging*; D014463:Ultrasonography