As airway experts, we have all been faced with intubating the difficult airway. We line up our toys, develop plans A, B, & C, and then go for it. After intubation, verification of tube placement is essential. The traditional methods of auscultation over the lung and the presence of a CO2 waveform are the gold standard. However, with the expanded use of the ultrasound in the operating room, there are other options.
An article by Pfeiffer P, et al published in Atca Anaesth Scand describes the use of the ultrasound for verification of endotracheal tube placement. The ultrasound can be used several ways to verify intubation. First, by scanning across the cricoid membrane, direct visualization of passage of the tube is possible. Several views in the neck area enable confirmation of tube passage. Ultrasound visualization of diaphragm movement indicates proper intubation. Finally, lung sliding with ventilation confirms tracheal intubation.
In this study, the group used the techniques described above and compared the time to verification using ultrasound versus the traditional auscultation and capnography. The study found that using the ultrasound for verification was reliable and equally quick as auscultation. When compared to auscultation plus capnography, the ultrasound verification was faster.
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