Evaluation oftranscricothyroid membrane ultrasonography and ultrasound guided pleural sliding sign for confirmation of endotracheal intubation

Year : 2018 | Volume : 6 | Issue : 3 Page : 32-36

Saundattikar Girish Y¹, Dongare Harshad C².

¹Professor and HOD,²Associate Professor, Smt. KashibaiNavale Medical College, Pune, Maharashtra, India.

Address for correspondence: Dongare Harshad C, Associate Professor,Smt. KashibaiNavale Medical College, Pune, Maharashtra, India.

Email: harshaddoc@gmail.com

Abstract

Introduction : There are many different ways of assessing the placement of endotracheal tube. However all techniques have certain limitations for some clinical situations.With the advent and easy availability of ultrasound machine in operation theatres,various ultrasound guided techniques are being evaluated for their feasibility and accuracy to confirm endotracheal tube placement.

Aim : The aim of the present study was to assess the sensitivity,specificity, positivepredictive value and negative predictive value of the pleural sliding sign on ultrasonography and transcricothyroid membrane ultrasonography for confirming endotracheal tube placement.

Materials & Methods: This was a prospective double blinded clinical trial carried out in operation theatre on patients who were to receive general anesthesia for various surgical procedures. 100 patients of American Society of Anesthesiologist (ASA) status I and II were enrolled for the study. During intubation a 6-13 MHz linear ultrasound probe was placed horizontally over the cricothyroid membrane. Endotracheal intubation was confirmed dynamically by transcricothyroid ultrasound. Then the same probe was used to assess presence of pleural sliding sign with intermittent positive pressure ventilation. This was followed by routine confirmation with waveform capnography and auscultation.

Statistical analysis: We calculatedthe sensitivity,specificity, positive predictive value and negative predictive value of both the tests.

Results: Out of 100, 8 patients had inadvertentoesophageal intubation. Sensitivity, Specificity, positive predictive value and negative predictive values were 97.83, 100%, 100% and 80% respectively for transcricothyroid ultrasound. With ultrasound lung sliding sign each were 100%.

Conclusion: Transcricothyroid ultrasound evaluation and positive lung sliding sign are useful methods to confirm endotracheal intubation

Keywords :Cricothyroid membrane, endotracheal intubation, pleural sliding, ultrasonography.