A prospective observational study to assess the diagnostic accuracy of suprasternal versus subxiphoid ultrasonography for endotracheal intubation in patients undergoing elective surgery

Safe airway management is a
priority in clinical care. Endotracheal intubation is an essential skill in
operating rooms, emergency department and intensive care units to safely
secure a patient’s airway. Rapid confirmation of the correct ET tube
placement is also important as incorrect placement is associated with adverse
outcomes. Endotracheal intubation is associated
with incorrect or displaced tubing in 6% to 25% of case

 The best approach to confirm correct placement of ET tube is observation of tube passage through vocal cords, followed by chest and epigastric auscultation.  Although no single confirmation technique is completely reliable, continuous waveform capnography, along with clinical evaluation, has been recommended to detect expiratory CO2 as the most reliable method for confirming correct tube placement. Methods used to confirm ETT must have a sensitivity of 100% in order to properly identify the esophageal intubation. In recent times, limited number of studies have been performed to confirm the endotracheal intubation by ultrasonography, where the placement of ET tube can be indirectly assessed by observing the pleura or diaphragm movement. Ultrasound can be used as a reliable method for confirmation, without any limitation

. This confirmation technique can be learned and practiced easily to reduce the hypoxia duration due to misplacement and prevent complications like aspiration.

The present study is focused on assessing the diagnostic accuracy of the two approaches of confirming the endotracheal intubation via ultrasonography ie, suprasternal approach where the passage of the ET tube through the trachea is observed and subxiphoid approach where diaphragmatic movements after endotracheal intubation are observed