Emergency Medicine: Open Access

Emergency Medicine: Open Access
Open Access

ISSN: 2165-7548

Editorial - (2014) Volume 4, Issue 3

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Role of Sonography for Post Intubation Confirmation

Hassan Soleimanpour1* and Farzad Rahmani2
1Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz 51664, Iran
2Emergency Medicine Department, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz 51664, Iran
*Corresponding Author: Hassan Soleimanpour, Associate professor of Anesthesiology and Critical Care, Fellowship in Trauma Critical Care and CPR, Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Daneshgah Street, Tabriz 51664, Iran, Fax: 984113352078 Email:

Editorial

Intubation and maintaining airway open is a critical procedure in the treatment of critically ill patients in the emergency department [1]. Intubating patients needing support of airway is performed by Rapid Sequence Intubation (RSI). After performing RSI, the physician should make sure from proper tracheal placement of the tracheal tube otherwise the esophageal intubation may occur leading to severe complications and death due to hypoxia [2].

Confirmation of proper tracheal intubation could be performed primarily by direct laryngoscopy, auscultation of Gurgling sounds in the epigastric region, lung auscultation, observation of water vapor on endotracheal tube wall, using esophageal detector device, CXR and ETCO2 (end-tidal CO2 pressure) that each of the above mentioned methods have its own limitations [1-6].

A new technique to confirm proper endotracheal intubation is trachea and chest ultrasound immediately after or during intubation. Chest ultrasound is an indirect method to show the movement of the lungs during ventilation through an endotracheal tube. This procedure can be performed instantly or within a few seconds.

A surface probe is used in this method; probe is placed between 2 and 3 intercostal space symmetrically on midclavicular line. The lungs are observed as lung sliding which considered like comet sign In case of tracheal intubation. Asymmetric vibration movements of the lungs indicate right main bronchus intubation and so tracheal tube should be pulled back [7,8].

Tracheal ultrasound during Endotracheal Intubation (ETI) also is called Tracheal Rapid Ultrasound Exam (TRUE). Ultrasound probe is set on the outside of larynx and glottis during intubation and tube passage through trachea is checked; two signs have been introduced in this method; bullet sign which is seen by passage of tracheal tube between the vocal cords and snow storm that is observed during intubation when tracheal tube passes trachea [8,9].

Chou HC and Osman Ad studies reported 98.2% and 98.1% overall accuracy by order for ultrasound in approving tube in trachea [10,11]. According to evaluations and mentioned topics, capnography is the standard test for confirming endotracheal intubation.

However, due to the limitations and time-consuming nature of this method and the fact that it does not show the ETCO2 values and is only used in patients with spontaneous pulse with no place in the cardiac arrest patients, introducing rapid and simple methods is essential.

Sonography, with high sensitivity for confirming intubation in cardiac arrest and Return of Spontaneous Circulation (ROSC) patients, can be used as a reliable and alternative modality in verifying intubation with wide applications compared to Capnography. However, further studies should be performed to confirm its accuracy.

References

  1. Pouraghaei M, Moharamzadeh P, Soleimanpour H, Rahmani F, Safari S, et al. (2014) Comparison between the effects of alfentanil, fentanyl and sufentanil on hemodynamic indices during rapid sequence intubation in the emergency department. Anesth Pain Med 4: e14618.
  2. Soleimanpour H, Sarahrudi K, Hadju S, Golzari SEJ (2012) How to Overcome Difficult-Bag-Mask-Ventilation: Recents Approaches. Emergency Med 2: e116.
  3. Soleimanpour H, Gholipouri C, Golzari SEJ, Rahmani F, Sabahi M et al. (2012) Capnography in the Emergency Department. Emergency Med 2: e123.
  4. Soleimanpour H, Gholipouri C, Panahi JR, Afhami MR, Ghafouri RR, et al. (2011) Role of anesthesiology curriculum in improving bag-mask ventilation and intubation success rates of Emerg Med (Los Angel) residents: a prospective descriptive study. BMC Emerg Med 11: 8.
  5. Mahmoodpoor A, Soleimanpour H, Nia KS, Panahi JR, Afhami M, et al. (2013) Sensitivity of palm print, modified mallampati score and 3-3-2 rule in prediction of difficult intubation. Int J Prev Med 4: 1063-1069.
  6. Golzari SE, Soleimanpour H, Mehryar H, Salarilak S, Mahmoodpoor A, et al. (2014) Comparison of three methods in improving Bag Mask Ventilation. Int J Prev Med [In Press]
  7. Volpicelli G (2011) Usefulness of emergency ultrasound in nontraumatic cardiac arrest. Am J Emerg Med 29: 216-223.
  8. Sustic A (2007) Role of ultrasound in the airway management of critically ill patients. Crit Care Med 35: S173-177.
  9. Singh M, Chin KJ, Chan VW, Wong DT, Prasad GA, et al. (2010) Use of sonography for airway assessment: an observational study. J Ultrasound Med 29: 79-85.
  10. Chou HC, Tseng WP, Wang CH, Ma MH, Wang HP, et al. (2011) Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation 82: 1279-1284.
  11. Osman A, Tan WC, Manikam R (2013) A feasibility study on bedside upper airway ultrasonography compared to waveform Capnography for verifying endotracheal tube location after intubation. Critical Ultrasound Journal 5: 7.
Citation: Soleimanpour H, Rahman F (2014) Role of Sonography for Post Intubation Confirmation. Emergency Med 4: e135.

Copyright: © 2014 Soleimanpour H, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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