Accuracy of Real-time Intratracheal Bedside Ultrasonography and Waveform Capnography for Confirmation of Intubation in Multiple Trauma Patients

Abstract

Background: A secure airway and effective ventilation are key components of advanced life support, and misplacement of endotracheal tube (ETT) can lead to morbidity in multiple trauma patients. The purpose of this study was to investigate the accuracy of ultrasound in diagnosis of direction for tracheal intubation. Materials and Methods: This descriptive-analytical study was conducted on 100 traumatic patients requiring intubation in 2016 in the Emergency Department of Al-Zahra and Kashani Medical Education Centers in Isfahan. Surface probe was placed transversally in the front of the neck at the top of the suprasternal notch, and the position of trachea was specified by front of comet-tail artifact which is the contour between hyperechoic air-mucosa (A-M) and a posterior reverberation artifact. Intubation accuracy by capnography was investigated, and the results were recorded in each patient's profile. Tracheal sonography was done during placement, or as soon as, the ETT has been embedded. The scanning time was minimized and it was carried out in total time of 10 s. Results: The diagnosis of intubation accuracy indicated that it was successful in 94 individuals (94) and unsuccessful in 6 ones (6). Intubation accuracy in 93 people (93) was confirmed, and inaccuracy of intubation in 7 people (7) was diagnosed. Ultrasound sensitivity in diagnosis of intubation accuracy was 97.9 (92.94) with 83.3 (5.6) specificity. The positive and negative predictive values were 98.9 (92.93) and 71.4 (5.7) respectively. Conclusion: Ultrasound method has high sensitivity and specificity to determine the correct placement of the tracheal tube, and it can be implemented as a reliable method given the acceptable positive and negative predictive values.