Positive Predictive Value of the Presence of Endotracheal(ETT) cuff ballotability above the Suprasternal notch in diagnosing the Correct positioning of ETT(PRESeNCE)-A prospective Observational study

Endotracheal intubation is one of the most common procedures used by anesthesiologists, intensivists and emergency personnel. But it can be associated with complications, such as carinal impingement or endobronchial intubation, which leads to increased incidence of barotrauma, contralateral lung collapse, or both, which result in hypoxemia and hemodynamic instability.

Three types of malposition can occur during intubation: one outside the trachea (esophageal), and two within the trachea: too shallow (hypopharyngeal/transglottic cuff), or too deep (endobronchial).

The various other methods for determining Endotracheal tube(ETT) placement are bilateral chest auscultation of equal air entry, chest X ray, fiberoptic bronchoscopy, capnography. However, these techniques are quite limited in actual clinical practice.

Ballotability of the ETT cuff over the anterior part of trachea above the supersternal space of Burns, could be a novel technique to confirm the proper ETT position.

Hence considering the simplicity of this test and its bedside/point of care utility, we

propose to investigate this method of cuff ballotment to verify the correct ETT

position and to explore its sensitivity, specificity, positive and negative predictive

value when compared with the gold standard of cervicothoracic Xray.