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Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial.
Saudi J Anaesth. 2020 Jan-Mar; 14(1):15-21.SJ

Abstract

Background

Anesthesia trainee may initially take longer time to intubate and unintentionally place the endotracheal tube (ETT) in the esophagus. The present study determined if ultrasound is the fastest method of confirmation of correct placement of ETT compared to capnography, and chest auscultation in trainees.

Methods

First year anesthesia residents performed intubation in 120 patients recruited after ethical clearance and informed consent. Time to visualize flutter in trachea, double trachea sign, time to appearance of first and sixth capnography, and time to execute chest auscultation was noted.

Results

Ultrasonography was statistically fastest method to determine endotracheal intubation (36.50 ± 15.14 seconds) vs unilateral chest auscultation (50.29 ± 15.50 seconds) vs bilateral chest auscultation (51.90 ± 15.98 seconds) vs capnography first waveform (53.57 ± 15.97 seconds) vs capnography sixth waveform (61.67 ± 15.88 seconds).

Conclusion

When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign.

Authors+Show Affiliations

Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31998014

Citation

Chowdhury, Apala Roy, et al. "Ultrasound Is a Reliable and Faster Tool for Confirmation of Endotracheal Intubation Compared to Chest Auscultation and Capnography when Performed By Novice Anaesthesia Residents - a Prospective Controlled Clinical Trial." Saudi Journal of Anaesthesia, vol. 14, no. 1, 2020, pp. 15-21.
Chowdhury AR, Punj J, Pandey R, et al. Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial. Saudi journal of anaesthesia. 2020;14(1):15-21.
Chowdhury, A. R., Punj, J., Pandey, R., Darlong, V., Sinha, R., & Bhoi, D. (2020). Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial. Saudi Journal of Anaesthesia, 14(1), 15-21. https://doi.org/10.4103/sja.SJA_180_19
Chowdhury AR, et al. Ultrasound Is a Reliable and Faster Tool for Confirmation of Endotracheal Intubation Compared to Chest Auscultation and Capnography when Performed By Novice Anaesthesia Residents - a Prospective Controlled Clinical Trial. Saudi journal of anaesthesia. 2020 Jan-Mar;14(1):15-21. PubMed PMID: 31998014.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial. AU - Chowdhury,Apala Roy, AU - Punj,Jyotsna, AU - Pandey,R, AU - Darlong,V, AU - Sinha,Renu, AU - Bhoi,D, Y1 - 2020/01/06/ PY - 2019/03/12/received PY - 2019/05/02/accepted PY - 2020/1/31/entrez PY - 2020/1/31/pubmed PY - 2020/1/31/medline KW - Endotracheal intubation KW - trainee anaesthetist KW - ultrasound SP - 15 EP - 21 JF - Saudi journal of anaesthesia VL - 14 IS - 1 N2 - Background: Anesthesia trainee may initially take longer time to intubate and unintentionally place the endotracheal tube (ETT) in the esophagus. The present study determined if ultrasound is the fastest method of confirmation of correct placement of ETT compared to capnography, and chest auscultation in trainees. Methods: First year anesthesia residents performed intubation in 120 patients recruited after ethical clearance and informed consent. Time to visualize flutter in trachea, double trachea sign, time to appearance of first and sixth capnography, and time to execute chest auscultation was noted. Results: Ultrasonography was statistically fastest method to determine endotracheal intubation (36.50 ± 15.14 seconds) vs unilateral chest auscultation (50.29 ± 15.50 seconds) vs bilateral chest auscultation (51.90 ± 15.98 seconds) vs capnography first waveform (53.57 ± 15.97 seconds) vs capnography sixth waveform (61.67 ± 15.88 seconds). Conclusion: When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign. SN - 1658-354X UR - https://www.unboundmedicine.com/medline/citation/31998014/Ultrasound_is_a_reliable_and_faster_tool_for_confirmation_of_endotracheal_intubation_compared_to_chest_auscultation_and_capnography_when_performed_by_novice_anaesthesia_residents___A_prospective_controlled_clinical_trial_ L2 - http://www.saudija.org/article.asp?issn=1658-354X;year=2020;volume=14;issue=1;spage=15;epage=21;aulast=Chowdhury DB - PRIME DP - Unbound Medicine ER -
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