<abstract xmlns="http://www.w3.org/1999/xhtml">

<p>
<bold>Aim:</bold> To compare the reliability of transtracheal ultrasound to confirm the endotracheal tube position with saline versus air inflated cuff. <bold>Methods:</bold> This was a prospective randomized cadaveric study. Four techniques were randomized: endotracheal tube in the trachea with air or saline inflated cuff, and endotracheal tube in the esophagus with air or saline inflated cuff. The investigator used the Mcgrath to randomly place the endotracheal tube in the trachea or in the esophagus with saline or air inflated cuff. During the first series of measurements, nine residents performed transtracheal ultrasound with linear transducer placed transversely at the suprasternal notch. They were recorded with a cut off fixed to 30 seconds, and a questionnaire was completed by the residents after each transtracheal ultrasound in order to report where the endotracheal tube is positioned according to them. The second series followed the same protocol and included three residents who had participated in the first series. The primary outcome was the success rate in determining the position of the endotracheal tube. <bold>Results:</bold> In the first series, the success rate was 46.5%. In the second series, the success rate was 72.9%. There was no significant difference between cuff inflated with saline and air (<italic>p</italic> = 1.00). The overall mean time required was 20.6 s (95% CI 13.0–28.2 s). Based on an empirical data set, transtracheal ultrasound had a sensitivity of 62.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 26.08%. <bold>Conclusion:</bold> This investigation shows that regardless of the contents of the endotracheal tube cuff, the use of transtracheal ultrasound to confirm the position of endotracheal tube reports disappointing results.</p>
</abstract>

Aim: To compare the reliability of transtracheal ultrasound to confirm the endotracheal tube position with saline versus air inflated cuff. Methods: This was a prospective randomized cadaveric study. Four techniques were randomized: endotracheal tube in the trachea with air or saline inflated cuff, and endotracheal tube in the esophagus with air or saline inflated cuff. The investigator used the Mcgrath to randomly place the endotracheal tube in the trachea or in the esophagus with saline or air inflated cuff. During the first series of measurements, nine residents performed transtracheal ultrasound with linear transducer placed transversely at the suprasternal notch. They were recorded with a cut off fixed to 30 seconds, and a questionnaire was completed by the residents after each transtracheal ultrasound in order to report where the endotracheal tube is positioned according to them. The second series followed the same protocol and included three residents who had participated in the first series. The primary outcome was the success rate in determining the position of the endotracheal tube. Results: In the first series, the success rate was 46.5%. In the second series, the success rate was 72.9%. There was no significant difference between cuff inflated with saline and air (p = 1.00). The overall mean time required was 20.6 s (95% CI 13.0–28.2 s). Based on an empirical data set, transtracheal ultrasound had a sensitivity of 62.2%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 26.08%. Conclusion: This investigation shows that regardless of the contents of the endotracheal tube cuff, the use of transtracheal ultrasound to confirm the position of endotracheal tube reports disappointing results.

Comparative study of the reliability of ultrasound to confirm the position of endotracheal tube with cuff inflated with saline versus air

Journal of Ultrasonography

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Aim: To compare the reliability of transtracheal ultrasound to confirm the endotracheal tube position with saline versus air inflated cuff. Methods: This was a...

Reference	Test	Sensitivity	Specificity	VPP	VPN
Empirical	esophagus	38.5	66.7	89.6	12.6
Empirical	trachea	62.2	100	100	26.1

	Failure N = 154 (53.5%)			Success N = 134 (46.5%)			p **
	N	%/mean	SD*	N	%/mean	SD*	p **
Endotracheal tube position							0.006
trachea	67	43.5		80	59.7
esophagus	87	56.5		54	40.3
Cuff							1.000
air	77	50.0		67	50.0
saline	77	50.0		67	50.0
Time	154	21.6	7.4	134	19.5	7.8	0.022

	1^st series N = 96 (50.0%)			2^nd series N = 96 (50.0%)			p **
	N	%/mean	SD*	N	%/mean	SD*	p **
Primary outcome							0.004
failure	45	46.9		26	27.1
success	51	53.1		70	72.9
Time	96	21.4	8.0	96	20.6	8.6	0.504

	N	%
Endotracheal tube position
Trachea	147	51
Esophagus	141	49
Cuff
Air	144	50
Saline	144	50
Primary outcome
Failure	154	53.5
Success	134	46.5
Diagnostic certainty
I don’t know	34	11.8
Not sure	47	16.3
Pretty sure	72	25.0
Almost sure	82	28.5
Quite sure	53	18.4
Visibility
I see nothing	39	13.5
Poor visibility	45	15.6
Average visibility	73	25.3
Good visibility	95	33.0
Very good visibility	36	12.5

Comparative study of the reliability of ultrasound to confirm the position of endotracheal tube with cuff inflated with saline versus air

Article Category: research-article

Published Online: Dec 15, 2021

Page range: 294 - 299

Received: May 16, 2021

Accepted: Sep 21, 2021

DOI: https://doi.org/10.15557/jou.2021.0050

Keywords
esophagus, trachea, endotracheal tube, transtracheal ultrasound, cuff, saline

© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Fig. 2.

Fig. 3.

Sensitivity, specificity, VPP, VPN

Techniques

Comparison of 1st and 2nd series of measurements

First series of measurements

Comparative study of the reliability of ultrasound to confirm the position of endotracheal tube with cuff inflated with saline versus air

Article Category: research-article

Published Online: Dec 15, 2021

Page range: 294 - 299

Received: May 16, 2021

Accepted: Sep 21, 2021

DOI: https://doi.org/10.15557/jou.2021.0050

Keywordsesophagus, trachea, endotracheal tube, transtracheal ultrasound, cuff, saline

© 2021 Polish Ultrasound Society. Published by Medical Communications Sp. z o.o.

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Fig. 1.

Fig. 2.

Fig. 3.

Sensitivity, specificity, VPP, VPN

Techniques

Comparison of 1st and 2nd series of measurements

First series of measurements

Keywords
esophagus, trachea, endotracheal tube, transtracheal ultrasound, cuff, saline