Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study
Objective: Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO2) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explore...
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| Format: | Article |
| Language: | English |
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Galenos Publishing House
2024-12-01
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| Series: | Turkish Journal of Anaesthesiology and Reanimation |
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| Online Access: | https://turkjanaesthesiolreanim.org/articles/focus-on-pocus-identification-of-early-successful-intubation-by-point-of-care-ultrasound-versus-end-tidal-carbon-dioxide-a-prospective-comparative-study/doi/TJAR.2024.241720 |
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| author | Soma Ganesh Raja Neethirajan Ganeshamoorthy Baskar Aruna Parameswari |
| author_facet | Soma Ganesh Raja Neethirajan Ganeshamoorthy Baskar Aruna Parameswari |
| author_sort | Soma Ganesh Raja Neethirajan |
| collection | DOAJ |
| description | Objective: Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO2) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explored the time-sensitive early recognition of successful endotracheal intubation by comparing ultrasound and etCO2 monitoring.
Methods: The study included 104 patients who were posted for elective surgery under general anaesthesia requiring endotracheal intubation. The time from removal of the face mask to ultrasound visualization of flutter in the trachea was compared with that of the appearance of six consecutive capnography waveforms following endotracheal intubation.
Results: Ultrasound was a faster tool for recognizing successful endotracheal intubation [(21.63±7.38) seconds] compared with capnography [(40.62±7.93) seconds].
Conclusion: eCO2 requires more time for 6 continuous waveforms to confirm successful intubation and has a false positive rate. Supplementing the gold standard etCO2 with ultrasound is faster and reliable in patients with low pulmonary blood flow without needing positive pressure ventilation, such as during cardiopulmonary resuscitation, in high-risk emergency intubations, such as in trauma, or in difficult airways where intubation can be confirmed in real time. Ultrasound is a reliable and faster tool for the early identification of successful endotracheal intubation than end-tidal carbon dioxide. |
| format | Article |
| id | doaj-art-5e419fc2e8bc49f9a9d4dd3f76a5d9ab |
| institution | Kabale University |
| issn | 2667-6370 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Turkish Journal of Anaesthesiology and Reanimation |
| spelling | doaj-art-5e419fc2e8bc49f9a9d4dd3f76a5d9ab2024-12-17T11:16:20ZengGalenos Publishing HouseTurkish Journal of Anaesthesiology and Reanimation2667-63702024-12-0152624024610.4274/TJAR.2024.241720Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative StudySoma Ganesh Raja Neethirajan0https://orcid.org/0000-0001-7800-4544Ganeshamoorthy Baskar1https://orcid.org/0009-0002-2586-5070Aruna Parameswari2https://orcid.org/0000-0002-1280-5047Sri Ramachandra Institute of Higher Education and Research Department of Anaesthesiology and Pain Medicine, Chennai, Tamilnadu, IndiaSri Ramachandra Institute of Higher Education and Research Department of Anaesthesiology and Pain Medicine, Chennai, Tamilnadu, IndiaSri Ramachandra Institute of Higher Education and Research Department of Anaesthesiology and Pain Medicine, Chennai, Tamilnadu, IndiaObjective: Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO2) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explored the time-sensitive early recognition of successful endotracheal intubation by comparing ultrasound and etCO2 monitoring. Methods: The study included 104 patients who were posted for elective surgery under general anaesthesia requiring endotracheal intubation. The time from removal of the face mask to ultrasound visualization of flutter in the trachea was compared with that of the appearance of six consecutive capnography waveforms following endotracheal intubation. Results: Ultrasound was a faster tool for recognizing successful endotracheal intubation [(21.63±7.38) seconds] compared with capnography [(40.62±7.93) seconds]. Conclusion: eCO2 requires more time for 6 continuous waveforms to confirm successful intubation and has a false positive rate. Supplementing the gold standard etCO2 with ultrasound is faster and reliable in patients with low pulmonary blood flow without needing positive pressure ventilation, such as during cardiopulmonary resuscitation, in high-risk emergency intubations, such as in trauma, or in difficult airways where intubation can be confirmed in real time. Ultrasound is a reliable and faster tool for the early identification of successful endotracheal intubation than end-tidal carbon dioxide.https://turkjanaesthesiolreanim.org/articles/focus-on-pocus-identification-of-early-successful-intubation-by-point-of-care-ultrasound-versus-end-tidal-carbon-dioxide-a-prospective-comparative-study/doi/TJAR.2024.241720airway managementend-tidal carbon-di-oxideendotracheal intubationintubationpocus |
| spellingShingle | Soma Ganesh Raja Neethirajan Ganeshamoorthy Baskar Aruna Parameswari Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study Turkish Journal of Anaesthesiology and Reanimation airway management end-tidal carbon-di-oxide endotracheal intubation intubation pocus |
| title | Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study |
| title_full | Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study |
| title_fullStr | Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study |
| title_full_unstemmed | Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study |
| title_short | Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study |
| title_sort | focus on pocus identification of early successful intubation by point of care ultrasound versus end tidal carbon dioxide a prospective comparative study |
| topic | airway management end-tidal carbon-di-oxide endotracheal intubation intubation pocus |
| url | https://turkjanaesthesiolreanim.org/articles/focus-on-pocus-identification-of-early-successful-intubation-by-point-of-care-ultrasound-versus-end-tidal-carbon-dioxide-a-prospective-comparative-study/doi/TJAR.2024.241720 |
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