Using Ultrasound to Confirm Endotracheal Tube Position in the Intensive Care Unit

It is important to confirm proper placement of the endotracheal tube (ETT) as there is significant morbidity and mortality associated with inadvertent esophageal intubation [13]. Endotracheal intubation is a frequently performed procedure in an intensive care unit (ICU) and an intensivist has to be adept at performing intubation and confirming ETT position [4]. An ideal technique to confirm the position of ETT is one that provides verification of tracheal location of the ETT at a level above the carina to ensure bilateral ventilation. The 2010 American Heart Association (AHA) guidelines for adult advanced life support (ACLS) recommend the use of both clinical assessment and confirmation devices to verify ETT placement [3]. Visualizing chest expansion, auscultating bilateral lung fields and epigastrium, along with continuous waveform capnography is considered the most reliable method of confirming correct ETT placement. Besides waveform capnography there are other confirmatory devices, such as, no waveform exhaled carbon dioxide detectors, esophageal detector devices, and transthoracic impedance detectors. Direct visualization of the glottis and passing the ETT under direct vision is considered the gold standard, but in many patients with difficult airways, it may not be possible to visualize the glottis [5].