Anesthesia & Clinical Research
Open Access

Abstract

Value of Integrated Tracheal and Lung Sliding Ultrasonography for Affirmation of Proper Endotracheal Tube Placement in Patients Undergoing Intubation for General Anesthesia

Huda Fahmy and Sayed Kinawy

Background: Integrated tracheal and lung sliding ultrasonography can distinguish tracheal, oesophageal, and endobronchial intubation.

Aim of the work: To estimate the accuracy and timeless of integrated tracheal and lung sliding ultrasonography for realization of proper endotracheal tube placement in patients undergoing intubation for general anesthesia.

Patients and methods: This prospective, observational study was carried out in the operative theatre (OT) on 80 patients who required intubation for general anesthesia during elective surgeries. Combined tracheal and lung sliding ultrasonography were done immediately after intubation, a data collection form included the patients' age, gender, BMI, modified Cormack-Lehane score, capnography results, ultrasonography results and the elapsed time before tube position affirmation was collected.

Results: Waveform capnography was able to detect endotracheal intubation in 74 (92.5%) patients and oesophageal intubation in six (7.5%) patients. Tracheal ultrasonography (TUS) was able to detect endotracheal intubation in 72 (90%) patients and oesophageal intubation in 8 (10%) patients with 95.95% sensitivity, 83.33% specificity, 98.6% PPV, 62.5% NPP, 95.00% accuracy. The ultra-sonographic sliding lung sign (SLS) was able to detect proper endotracheal intubation in 69 (86.3%) patients, oesophageal intubation in 6 (7.5%) patients and right main stem intubation in 5 (6.2%) cases with higher specificity, PPV (100% both), but with lower sensitivity, NPP (93.24%, 54.5% respectively) and the diagnostic accuracy was (93.75%). On combining TUS and SLS, the sensitivity and negative predictive values raised to 100% and the diagnostic accuracy rise to (98.75%). The overall duration of ultrasonography was considerably lower than that of capnography (P<0.001) with a mean difference of 5 seconds in favor of ultrasound.

Conclusion: The integration of tracheal and lung sliding ultrasonography provide a new protocol for more comprehensive affirmation of proper endotracheal tube position after general anesthesia. Anesthesiologists should be familiar with these procedures to prove both correct intubation and proper ventilation after general anesthesia.