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Monday, November 30, 2015

ResUS Pearl: Confirmation of ETT Placement

POCUS can be used as an adjunct method for verification of proper endotracheal tube (ETT) placement, and can be used in real-time during or immediately following laryngoscopy.

Advantages
Helpful for emergency intubations where ETCO₂ has a higher error rate:
  • Cardiac Arrest 
  • Status Asthmaticus
  • Pulmonary Edema
  • Pulmonary Embolism 

Additionally, unlike ETCO₂ detectors, ultrasound can help confirm appropriate ETT depth.


Technique
Place a high frequency linear probe in the transverse position just cephalad to the suprasternal notch.




US Findings
Several different confirmatory findings have been described to determine ETT location, primarily relying on the exclusion of esophageal intubation. To date, there is no sonographic finding that is widely accepted amongst investigators.









References
American College of Emergency Physicians Board of Directors. Verification of Endotracheal Tube Placement. policy statement. Revised April 2009.

Favot, M. Ultrasound for Verification of Endotracheal Tube Location. Academic Life in Emergency Medicine.  March 2015.

Submitted by: A Hughes, MD

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