title: Rapidity and efficacy of ultrasonographic sliding lung sign and auscultation in confirming endotracheal intubation in overweight and obese patients.
abstract: OBJECTIVE
  Obese individuals are predisposed to difficult airway and intubation. They usually yield confusing or misleading auscultatory findings. We aimed to assess the rapidity and efficacy of ultrasonographic (USG) sliding lung sign for confirming endotracheal intubation in normal as well as overweight and obese surgical patients.
  
  
  METHODS
  This prospective, observational study was performed in forty surgical patients. Twenty patients with body mass index (BMI) <25 were recruited to Group A, whereas twenty patients with BMI ≥25 constituted Group B. Following induction and intubation, appearance of end-tidal carbon dioxide waveform was used to confirm endotracheal intubation. Presence of breath sounds bilaterally was sought by auscultation, and time taken for auscultatory confirmation was noted. The USG confirmation of air entry to the lung field as indicated by lung sliding was sought, and the time taken was noted. Chi-square test, independentt-test and pairedt-test were used as applicable.
  
  
  RESULTS
  Auscultatory confirmation was more rapid in Group A as compared to Group B (9.34 ± 2.43 s vs. 14.35 ± 5.53 s,P= 0.001). However, there was no significant difference in USG confirmation time in both the groups (8.57 ± 2.05 s vs. 8.61 ± 1.66 s). Four patients in Group B had doubtful breath sounds against none in Group A. There was no doubtful lung slide with USG in both groups. One case of endobronchial intubation in Group B was diagnosed with USG which was doubtful by auscultation.
  
  
  CONCLUSIONS
  Ultrasound directed confirmation of endotracheal tube placement in overweight and obese patients is superior in speed and accuracy in comparison to the standard auscultatory method.
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Jayasankar
authors.initials: J
authors.lastname: Surendran
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Jerry
authors.initials: J
authors.lastname: Paul
authors.affiliation: Department of Anaesthesiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Kumar
keywords: Auscultation; endotracheal intubation; obesity; sliding lung sign; ultrasonography