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Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography.
Acta Anaesthesiol Scand. 2012 May; 56(5):571-6.AA

Abstract

BACKGROUND

Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for verifying endotracheal intubation in obese patients.

METHODS

A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography.

RESULTS

Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P < 0.0001.

CONCLUSION

In obese patients, verification of endotracheal tube placement with US is as fast as auscultation alone and faster than the standard method of auscultation and capnography.

Authors+Show Affiliations

Akutcentrum/Anestesikliniken, Skåne University Hospital, SUS Malmø, Sweden. peter.pfeiffer@skane.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22260400

Citation

Pfeiffer, P, et al. "Verification of Endotracheal Intubation in Obese Patients - Temporal Comparison of Ultrasound Vs. Auscultation and Capnography." Acta Anaesthesiologica Scandinavica, vol. 56, no. 5, 2012, pp. 571-6.
Pfeiffer P, Bache S, Isbye DL, et al. Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography. Acta Anaesthesiol Scand. 2012;56(5):571-6.
Pfeiffer, P., Bache, S., Isbye, D. L., Rudolph, S. S., Rovsing, L., & Børglum, J. (2012). Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography. Acta Anaesthesiologica Scandinavica, 56(5), 571-6. https://doi.org/10.1111/j.1399-6576.2011.02630.x
Pfeiffer P, et al. Verification of Endotracheal Intubation in Obese Patients - Temporal Comparison of Ultrasound Vs. Auscultation and Capnography. Acta Anaesthesiol Scand. 2012;56(5):571-6. PubMed PMID: 22260400.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Verification of endotracheal intubation in obese patients - temporal comparison of ultrasound vs. auscultation and capnography. AU - Pfeiffer,P, AU - Bache,S, AU - Isbye,D L, AU - Rudolph,S S, AU - Rovsing,L, AU - Børglum,J, Y1 - 2012/01/19/ PY - 2011/11/29/accepted PY - 2012/1/21/entrez PY - 2012/1/21/pubmed PY - 2012/8/10/medline SP - 571 EP - 6 JF - Acta anaesthesiologica Scandinavica JO - Acta Anaesthesiol Scand VL - 56 IS - 5 N2 - BACKGROUND: Ultrasound (US) may have an emerging role as an adjunct in verification of endotracheal intubation. Obtaining optimal US images in obese patients is generally regarded more difficult than for other patients. This study compared the time consumption of bilateral lung US with auscultation and capnography for verifying endotracheal intubation in obese patients. METHODS: A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography. RESULTS: Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P < 0.0001. CONCLUSION: In obese patients, verification of endotracheal tube placement with US is as fast as auscultation alone and faster than the standard method of auscultation and capnography. SN - 1399-6576 UR - https://www.unboundmedicine.com/medline/citation/22260400/Verification_of_endotracheal_intubation_in_obese_patients___temporal_comparison_of_ultrasound_vs__auscultation_and_capnography_ L2 - https://doi.org/10.1111/j.1399-6576.2011.02630.x DB - PRIME DP - Unbound Medicine ER -