Airway Ultrasonography and End-tidal Capnography for early confirmation of endotracheal tube placement : An observational study

It is important to confirm proper placement of endotracheal(ET) tube as inadvertent esophageal intubation is associated with catastrophic consequences. Quantitative waveform capnography is currently the gold standard and most sensitive method for confirmation of ET tube.However it has some limitations like its accuracy may be compromised in patients suffering from pulmonary embolism or those in cardiac arrest. Also respiration must be maintained for several breaths to accurately confirm the ET tube placement and this can lead to fatal regurgitation and aspiration in full stomach patients being ventilated with a misplaced esophageal tube. Thirdly capnography may provide false negative results in case of severe airway obstruction or use of epinephrine. Ultrasound guided confirmation of correct ET tube placement has been described in adults with high sensitivity and specificity in both controlled operating room conditions and emergency or ICU settings.Ultrasound is a novel tool, provides real time view and can be performed quickly. Furthermore it is independent of pulmonary blood flow and does not require lung ventilation. We plan to do prospective observational study to compare upper airway(tracheal) USG with reference to capnography( the gold standard) for early confirmation of ET tube placement.