Confirmation of intubation in emergency department: Ultrasonography

Aim of study: The use of USG in diagnosis and treatment becomes on the increase in emergency departments. The aim of this study to research the role of USG in confirmation of ETT placement, diagnosis and contribution to treatment. Method: This was a prospective, single center, observational study,conducted between 01.04.2012 and 31.01.2013 in Gazi University Hospital of Emergency Department. We include the patients above 18 year old and non of trauma, neck and chest deformity and known pneumothoraks. Poition of intubations confirmed by End Tidal CO2 and chest x-ray. During intubation concurrently USG used to larynx transition and chest ventilation; and by auscultation looked to chest and stomach ventilation. Time of diagnosis were calculate with each procedure. Results: Of the eligibl 92 patients were included with median age 69 (min. 20- max. 94), 36 (%39,1) women and 56 (%60,1) men. 36 (%39,1) patients intubated with arrest and 56 (%60,9) patients with other problems. The most common comorbid disease was cardiac diseases 41 (%44,6). To confirm the position of intubation there were any significant differance between USG and auscultation (p= 0.083), on the other hand USG significantly faster than auscultation (p<0.05). However USG has false positive result in 2 patients. The sensitivity of USG against kapnograph was 98,7%, spesificity 93,8%, NPV 93,8% and PPV 98,7%. The ? value os USG was 0,924. Conclusion: Although USG being a user dependent test, due to its advantages as being fast, achieve good verification rates and early detection of esophagus intubation, could be use as secondary verification test in position of ETT.