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2000
Volume 5, Issue 1
  • ISSN: 0250-6882
  • E-ISSN: 0250-6882
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Abstract

Background

The traditional methods are mostly used to detect tracheal localization and to exclude esophageal localization. Therefore, the aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube.

Methods

Out-of-hospital ETE was performed by experienced paramedics working in the emergency ambulance service, while ETE in the emergency department was performed by emergency medicine residents or emergency medicine specialists with at least 2 years of emergency department experience. Epigastric compression was performed by applying pressure to the epigastric region at least three times (in 5 sec) with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask. Immediately after ETI was performed, Ultrasonography (USG) was performed as the gold standard confirmation method. If a double path sign was observed and the pleural sliding motion was not seen, it was considered unsuccessful.

Results

A total of 78 patients were included in the study (an equal number of successful and unsuccessful ETE applications). Approximately 59% (n=46) of the patients were female, median age was 73 years (64-80), and 22(28.2%) patients were intubated due to traumatic etiology. The specificity and sensitivity of epigastric fluctuation for esophageal intubations were 83.33% and 60%, respectively. The positive predictive value was 92.31%, and the negative predictive value was 38.46%. Epigastric auscultation airflow sound had a specificity of 86.96% and a sensitivity of 65.45% for esophageal intubation.

Conclusion

Although the fluctuation that occurs in the tube with epigastric compression is not as sensitive and specific as USG, it is a better method than lung auscultation.

© 2024 The Author(s).
© 2024 The Author(s). Published by Bentham Science Publishers. This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode
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2024-01-01
2025-10-31

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References

  1. FarrokhiM. YarmohammadiB. MangouriA. HekmatniaY. BahramvandY. KianiM. NasrollahiE. Nazari-SabetM. Manoochehri-ArashN. KhurshidM. MosalanejadS. HajizadehV. Amani-BeniR. MoallemM. FarahmandsadrM. Screening performance characteristics of ultrasonography in confirmation of endotracheal intubation; A systematic review and meta-analysis.Arch. Acad. Emerg. Med.202191e6834870234
     [Google Scholar]
  2. LinJ. BellingerR. SheddA. WolfshohlJ. WalkerJ. HealyJ. TaylorJ. ChaoK. YenY.H. TzengC.F.T. ChouE.H. Point-of-care ultrasound in airway evaluation and management: A comprehensive review.Diagnostics2023139154110.3390/diagnostics1309154137174933
     [Google Scholar]
  3. GottliebM. O’BrienJ.R. FerrignoN. SundaramT. Point-of-care ultrasound for airway management in the emergency and critical care setting.Clin. Exp. Emerg. Med.2023111223210.15441/ceem.23.09437620036
     [Google Scholar]
  4. PunjJ. ChowdhuryA.R. PandeyR. DarlongV. SinhaR. BhoiD. Ultrasound is a reliable and faster tool for confirmation of endotracheal intubation compared to chest auscultation and capnography when performed by novice anaesthesia residents - A prospective controlled clinical trial.Saudi J. Anaesth.2020141152110.4103/sja.SJA_180_1931998014
     [Google Scholar]
  5. WangH.E. BengerJ.R. Endotracheal intubation during out‐of‐hospital cardiac arrest: New insights from recent clinical trials.J. Am. Coll. Emerg. Physicians Open202011242910.1002/emp2.1200333000010
     [Google Scholar]
  6. HanselJ. LawJ.A. ChrimesN. HiggsA. CookT.M. Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: A diagnostic test accuracy systematic review and meta‐analysis.Anaesthesia20237881020103010.1111/anae.1605937325847
     [Google Scholar]
  7. ChenkinJ. McCartneyC.J.L. JelicT. RomanoM. HeslopC. BandieraG. Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians.Crit. Ultrasound J.2015711410.1186/s13089‑015‑0031‑726383011
     [Google Scholar]
  8. GrmecŠ. Comparison of three different methods to confirm tracheal tube placement in emergency intubation.Intensive Care Med.200228670170410.1007/s00134‑002‑1290‑x12107674
     [Google Scholar]
  9. RoyP.S. JoshiN. GargM. MeenaR. BhatiS. Comparison of ultrasonography, clinical method and capnography for detecting correct endotracheal tube placement: A prospective, observational study.Indian J. Anaesth.2022661282683110.4103/ija.ija_240_2236654895
     [Google Scholar]
  10. ParkL. ZengI. BrainardA. Systematic review and meta‐analysis of first‐pass success rates in emergency department intubation: Creating a benchmark for emergency airway care.Emerg. Med. Australas.2017291404710.1111/1742‑6723.1270427785883
     [Google Scholar]
  11. KimC. KangH.G. LimT.H. ChoiB.Y. ShinY. ChoiH.J. What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?Emerg. Med. J.2013301188889210.1136/emermed‑2012‑20170823243044
     [Google Scholar]
  12. ChrimesN. HiggsA. HagbergC.A. BakerP.A. CooperR.M. GreifR. KovacsG. LawJ.A. MarshallS.D. MyatraS.N. O’SullivanE.P. RosenblattW.H. RossC.H. SaklesJ.C. SorbelloM. CookT.M. Preventing unrecognised oesophageal intubation: A consensus guideline from the project for universal management of airways and international airway societies.Anaesthesia202277121395141510.1111/anae.1581735977431
     [Google Scholar]
  13. ChenW. ChenJ. WangH. ChenY. Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit.J. Int. Med. Res.2020484030006051989477110.1177/030006051989477131880180
     [Google Scholar]
  14. LiX. ZhangJ. KarunakaranM. HariharanV.S. Diagnostic accuracy of ultrasonography for the confirmation of endotracheal tube intubation: A systematic review and meta-analysis.Med. Ultrason.2023251728110.11152/mu‑359436780595
     [Google Scholar]
  15. Kramer-JohansenJ. DorphE. SteenP.A. Detection of carbon dioxide in expired air after oesophageal intubation; the role of bystander mouth‐to‐mouth ventilation.Acta Anaesthesiol. Scand.200852115515710.1111/j.1399‑6576.2007.01503.x17999713
     [Google Scholar]
  16. SandroniC. De SantisP. D’ArrigoS. Capnography during cardiac arrest.Resuscitation2018132737710.1016/j.resuscitation.2018.08.01830142399
     [Google Scholar]
  17. MaskayS.S. ShresthaN. BastolaP. PradhanB. ShresthaA. Ultrasonography imaging versus waveform capnography in detecting endotracheal tube placement during intubation at a tertiary hospital.J. Med. Ultrasound2023321707510.4103/jmu.jmu_98_2238665336
     [Google Scholar]
  18. LiJ. Capnography alone is imperfect for endotracheal tube placement confirmation during emergency intubation.J. Emerg. Med.200120322322910.1016/S0736‑4679(00)00318‑811267809
     [Google Scholar]
  19. SilvestriS. LaddeJ.G. BrownJ.F. RoaJ.V. HunterC. RallsG.A. PapaL. Endotracheal tube placement confirmation: 100% sensitivity and specificity with sustained four-phase capnographic waveforms in a cadaveric experimental model.Resuscitation201711519219810.1016/j.resuscitation.2017.01.00228111195
     [Google Scholar]
  20. LawJ.A. DugganL.V. AsselinM. BakerP. CrosbyE. DowneyA. HungO.R. JonesP.M. LemayF. NoppensR. ParottoM. PrestonR. SowersN. SparrowK. TurkstraT.P. WongD.T. KovacsG. Canadian Airway Focus Group Canadian airway focus group updated consensus-based recommendations for management of the difficult airway: Part 1. Difficult airway management encountered in an unconscious patient.Can. J. Anaesth.20216891373140410.1007/s12630‑021‑02007‑034143394
     [Google Scholar]
  21. GrmecS. MallyS. Prehospital determination of tracheal tube placement in severe head injury.Emerg. Med. J.200421451852015208251
     [Google Scholar]
  22. AlenaziA. AlshibaniA. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature.Heliyon2024107e2847910.1016/j.heliyon.2024.e2847938586363
     [Google Scholar]
  23. BhatR. YadavP. BhaskararayuniJ. NeseemA. NageshS.K. MishraP.R. Laryngeal mask airway bougie ultrasonography guided intubation in a morbidly obese patient with difficult airway.World J. Emerg. Med.202314324124310.5847/wjem.j.1920‑8642.2023.05037152529
     [Google Scholar]
  24. CongediS. SavioF. AucielloM. SalvadoriS. NardoD. BonadiesL. Sonographic evaluation of the endotracheal tube position in the neonatal population: A comprehensive review and meta-analysis.Front Pediatr.20221088645010.3389/fped.2022.88645035722478
     [Google Scholar]
/content/journals/nemj/10.2174/0102506882369196250326072120
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Can the Fluctuation Observed in the Endotracheal Tube with Compression Applied to the Epigastric Region be Used as a Confirmation Method for Endotracheal Intubation?
NEW Emirates Medical J 5, E02506882369196 (2024); https://doi.org/10.2174/0102506882369196250326072120
/content/journals/nemj/10.2174/0102506882369196250326072120
/content/journals/nemj/10.2174/0102506882369196250326072120
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  • Article Type:     Research Article
Keyword(s): Balloon-valved mask; Chest X-ray; CPR; Endotracheal intubation; Epigastric fluctuation; Esophageal placement; Intubation

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