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Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis.
Can J Anaesth. 2015 Apr; 62(4):413-23.CJ

Abstract

PURPOSE

Early confirmation of endotracheal tube placement is of paramount importance to prevent hypoxia and its catastrophic consequences. Despite certain limitations, capnography is considered the gold standard to evaluate the proper placement of an endotracheal tube. Ultrasound is a novel tool with some definitive advantages over capnography. It enables a real-time view and can be performed quickly; furthermore, it is independent of pulmonary blood flow and does not require lung ventilation. In this review, we aimed to evaluate the diagnostic accuracy of transtracheal ultrasound in detecting endotracheal intubation.

SOURCE

We completed an extensive search of MEDLINE®, EMBASE™, The Cochrane Library, KoreaMed, LILACS, OpenGrey, and the World Health Organization International Clinical Trials Registry from their inception to September 4, 2014. The studies that met the inclusion criteria were pooled and a meta-analysis was conducted.

PRINCIPAL FINDINGS

Eleven studies and 969 intubations were included in the final analysis. Eight studies and 713 intubations were performed in emergency situations and the others were carried out in elective situations. Transtracheal ultrasonography's pooled sensitivity and specificity with 95% confidence intervals (CIs) were 0.98 (95% CI 0.97 to 0.99) and 0.98 (95% CI 0.95 to 0.99), respectively. In emergency scenarios, transtracheal ultrasonography showed an aggregate sensitivity and specificity of 0.98 (95% CI 0.97 to 0.99) and 0.94 (95% CI 0.86 to 0.98), respectively.

CONCLUSION

Transtracheal ultrasound is a useful tool to confirm endotracheal intubation with an acceptable degree of sensitivity and specificity. It can be used in emergency situations as a preliminary test before final confirmation by capnography.

Authors+Show Affiliations

Department of Anesthesia and Critical Care, Nazareth Hospital, Shillong, 793003, Meghalaya, India, drsauravdas1977@gmail.com.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

25537734

Citation

Das, Saurabh Kumar, et al. "Transtracheal Ultrasound for Verification of Endotracheal Tube Placement: a Systematic Review and Meta-analysis." Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, vol. 62, no. 4, 2015, pp. 413-23.
Das SK, Choupoo NS, Haldar R, et al. Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Can J Anaesth. 2015;62(4):413-23.
Das, S. K., Choupoo, N. S., Haldar, R., & Lahkar, A. (2015). Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Canadian Journal of Anaesthesia = Journal Canadien D'anesthesie, 62(4), 413-23. https://doi.org/10.1007/s12630-014-0301-z
Das SK, et al. Transtracheal Ultrasound for Verification of Endotracheal Tube Placement: a Systematic Review and Meta-analysis. Can J Anaesth. 2015;62(4):413-23. PubMed PMID: 25537734.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. AU - Das,Saurabh Kumar, AU - Choupoo,Nang Sujali, AU - Haldar,Rudrashish, AU - Lahkar,Amitabh, Y1 - 2014/12/24/ PY - 2014/05/15/received PY - 2014/12/09/accepted PY - 2014/12/25/entrez PY - 2014/12/30/pubmed PY - 2015/12/30/medline SP - 413 EP - 23 JF - Canadian journal of anaesthesia = Journal canadien d'anesthesie JO - Can J Anaesth VL - 62 IS - 4 N2 - PURPOSE: Early confirmation of endotracheal tube placement is of paramount importance to prevent hypoxia and its catastrophic consequences. Despite certain limitations, capnography is considered the gold standard to evaluate the proper placement of an endotracheal tube. Ultrasound is a novel tool with some definitive advantages over capnography. It enables a real-time view and can be performed quickly; furthermore, it is independent of pulmonary blood flow and does not require lung ventilation. In this review, we aimed to evaluate the diagnostic accuracy of transtracheal ultrasound in detecting endotracheal intubation. SOURCE: We completed an extensive search of MEDLINE®, EMBASE™, The Cochrane Library, KoreaMed, LILACS, OpenGrey, and the World Health Organization International Clinical Trials Registry from their inception to September 4, 2014. The studies that met the inclusion criteria were pooled and a meta-analysis was conducted. PRINCIPAL FINDINGS: Eleven studies and 969 intubations were included in the final analysis. Eight studies and 713 intubations were performed in emergency situations and the others were carried out in elective situations. Transtracheal ultrasonography's pooled sensitivity and specificity with 95% confidence intervals (CIs) were 0.98 (95% CI 0.97 to 0.99) and 0.98 (95% CI 0.95 to 0.99), respectively. In emergency scenarios, transtracheal ultrasonography showed an aggregate sensitivity and specificity of 0.98 (95% CI 0.97 to 0.99) and 0.94 (95% CI 0.86 to 0.98), respectively. CONCLUSION: Transtracheal ultrasound is a useful tool to confirm endotracheal intubation with an acceptable degree of sensitivity and specificity. It can be used in emergency situations as a preliminary test before final confirmation by capnography. SN - 1496-8975 UR - https://www.unboundmedicine.com/medline/citation/25537734/Transtracheal_ultrasound_for_verification_of_endotracheal_tube_placement:_a_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1007/s12630-014-0301-z DB - PRIME DP - Unbound Medicine ER -