title: Optimization of Ultrasound Transducer Positioning for Endotracheal Tube Placement Confirmation in Cadaveric Model.
abstract: OBJECTIVE
  Sonography has been suggested as a possible means of endotracheal tube (ETT) placement confirmation. However, optimum ultrasound transducer placement has not been established. Using a cadaveric model, ETT placement by the sonographic appearance at the thyroid cartilage, cricoid cartilage, and suprasternal notch in the upper airway was assessed to determine which ultrasound transducer placement offered the most optimal images for ETT confirmation in the airway.
  
  
  METHODS
  One provider intubated 5 cadavers, with the ultrasound transducer at each of the 3 levels, for a total of 30 intubations per specimen, while 2 providers assigned a visual score of 1 (subtle), 2 (clear), or 3 (pronounced) to each sonogram of the ETT in the airway.
  
  
  RESULTS
  At the level of the thyroid cartilage, tracheal intubation was detected at a rate of 40%, with a median visualization scale of 1 (subtle movement). At the level of the cricoid cartilage, the visualization scale improved to a median of 2 (clear movement), with a 70% intubation detection rate. At the level of the suprasternal notch, 100% of the tracheal intubations were visualized on sonography, with a median score of 3 (pronounced movement).
  
  
  CONCLUSIONS
  In comparing sonographic detection of ETT placement at 3 levels of the upper airway in a cadaveric model, our results clearly indicate that visualization was superior at the level of the suprasternal notch, with 100% of intubations detected with the best visualization scores.
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Lonchena
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Sokpoleak
authors.initials: S
authors.lastname: So
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: James
authors.initials: J
authors.lastname: Ibinson
authors.affiliation: Center for Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Roolf
authors.affiliation: Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Orebaugh
mesh_terms: D002102:Cadaver; D003413:Cricoid Cartilage / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D007830:Larynx / Q000033:anatomy & histology*; D008297:Male; D056888:Patient Positioning; D012680:Sensitivity and Specificity; D013957:Thyroid Cartilage / Q000033:anatomy & histology*; D014159:Transducers; D014463:Ultrasonography / Q000295:instrumentation*
keywords: airway; anatomy; emergency; endotracheal tube; general and abdominal ultrasound; intubation; sonography