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A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians.
J Ultrasound Med. 2017 Oct; 36(10):2079-2085.JU

Abstract

OBJECTIVES

Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation.

METHODS

We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement.

RESULTS

Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training.

CONCLUSIONS

A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position.

Authors+Show Affiliations

Department of Emergency Medicine, University of California, Irvine, Orange, California, USA.Department of Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada, USA.Department of Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada, USA.Department of Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada, USA.Department of Emergency Medicine, University of California, Irvine, Orange, California, USA.Department of Emergency Medicine, University of California, Irvine, Orange, California, USA.Department of Emergency Medicine, University of Nevada School of Medicine, Las Vegas, Nevada, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28503749

Citation

Lahham, Shadi, et al. "A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation By Emergency Medicine Resident Physicians." Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, vol. 36, no. 10, 2017, pp. 2079-2085.
Lahham S, Baydoun J, Bailey J, et al. A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians. J Ultrasound Med. 2017;36(10):2079-2085.
Lahham, S., Baydoun, J., Bailey, J., Sandoval, S., Wilson, S. P., Fox, J. C., & Slattery, D. E. (2017). A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, 36(10), 2079-2085. https://doi.org/10.1002/jum.14231
Lahham S, et al. A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation By Emergency Medicine Resident Physicians. J Ultrasound Med. 2017;36(10):2079-2085. PubMed PMID: 28503749.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Prospective Evaluation of Transverse Tracheal Sonography During Emergent Intubation by Emergency Medicine Resident Physicians. AU - Lahham,Shadi, AU - Baydoun,Jamie, AU - Bailey,James, AU - Sandoval,Sandra, AU - Wilson,Sean P, AU - Fox,John C, AU - Slattery,David E, Y1 - 2017/05/15/ PY - 2016/12/27/received PY - 2017/01/13/accepted PY - 2017/5/16/pubmed PY - 2018/6/12/medline PY - 2017/5/16/entrez KW - airway confirmation KW - emergency medicine KW - intubation KW - sonography SP - 2079 EP - 2085 JF - Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine JO - J Ultrasound Med VL - 36 IS - 10 N2 - OBJECTIVES: Establishing a definitive airway is often the first step in emergency department treatment of critically ill patients. Currently, there is no agreed upon consensus as to the most efficacious method of airway confirmation. Our objective was to determine the diagnostic accuracy of real-time sonography performed by resident physicians to confirm placement of the endotracheal tube during emergent intubation. METHODS: We performed a prospective cohort study of adult patients in the emergency department undergoing emergent endotracheal intubation. Thirty emergency medicine residents, who were blinded to end-tidal carbon dioxide detection results, performed real-time transverse tracheal sonography during intubation to evaluate correct endotracheal tube placement. RESULTS: Seventy-two patients were enrolled in the study. Sixty-eight instances (94.4%) were interpreted as correct placement in the trachea; 4 (5.6%) were interpreted as esophageal, of which 1 was a false-negative finding, therefore conferring sensitivity of 98.5% (95% confidence interval, 92.1%-99.9%) and specificity of 75.0% (95% confidence interval, 19.4%-99.4%) for correct placement. There was no significant difference in accuracy among resident sonographers with different levels of residency training. CONCLUSIONS: A simple transverse tracheal sonographic examination performed by emergency medicine resident physicians can be used as an adjunct to help confirm correct endotracheal tube placement during intubation. In our cohort, the level of training did not appear to affect the ability of residents to correctly identify the endotracheal tube position. SN - 1550-9613 UR - https://www.unboundmedicine.com/medline/citation/28503749/A_Prospective_Evaluation_of_Transverse_Tracheal_Sonography_During_Emergent_Intubation_by_Emergency_Medicine_Resident_Physicians_ L2 - https://doi.org/10.1002/jum.14231 DB - PRIME DP - Unbound Medicine ER -