Efficacy of Airway Ultrasound in the Confirmation of Endotracheal Tube Placement in Children is Comparable to Capnograph and better than Auscultation

Background: Confirmation of correct placement of endotracheal tube is mostly done by capnography (the gold standard) and auscultation, but both methods have their limitations. Airway ultrasonography is a non-invasive diagnostic imaging technique that has been shown to correctly delineate the airway structures and confirm correct placement of endotracheal tube during general anaesthesia. This study aimed at comparing the accuracy of airway ultrasound with auscultation using capnograph as the gold standard.. Patients and Method: This prospective randomized controlled clinical trial involved 106 American Society of Anesthesiologists I and II patients aged 1-10 years who presented for elective surgery and required general anaesthesia. After intubation, the endotracheal tube placement was confirmed with airway ultrasonography and five-point auscultation and compared with capnography in all the patients. The time of intubation and confirmation of correct placement of endotracheal tube by the three methods: airway ultrasound, auscultation and time to five waveforms on the capnograph were recorded. Results: When compared with capnography, airway ultrasonography showed accuracy, sensitivity and specificity of 100% while auscultation showed accuracy, sensitivity and specificity of 94.3%, 97.0% and 57.1% respectively. The time required for confirmation of endotracheal tube position was observed to be significantly lower with airway ultrasonography (average time of 6.68 ± 2.1s) than both capnography (25.81 ± 6.9s) and auscultation (29.29 ± 9.0s) respectively with a p value of <0.001. Conclusion: Data from this study show that airway ultrasonography confirmed correct placement more accurately than auscultation when compared with capnography. Ultrasound is a simple, accurate, non-invasive and fast method for confirming paediatric endotracheal tube placement.