A comparative study on confirmation of endotracheal tube placement in patients undergoing intubation in emergency department with ultrasonography, clinical methods, and capnography

Abstract Background and Objective Endotracheal intubation is a lifesaving procedure in critically ill patients. This study compared ultrasonography with 5‐point auscultation and the gold standard, quantitative waveform capnography, for confirming tube placement. Sensitivity, specificity, and time taken to confirm each method were evaluated, along with the frequency of tracheal and esophageal intubations. Methods This hospital‐based single‐center observational study was conducted in the emergency department of a tertiary care hospital. Three observers independently confirmed tube position after intubation using 5‐point auscultation, ultrasonography, and waveform capnography, with time to confirmation recorded simultaneously. Results 88 patients were included, out of which, four had esophageal intubation. A single A–M interface was observed in 94.3% of patients, confirming tracheal placement. Agreement between ultrasonography and 5‐point auscultation showed a kappa ( k ) value of 0.918 ( p = 0.001), whereas ultrasonography and capnography also had a kappa of 0.918, both indicating strong agreement. The mean confirmation times were as follows: ultrasonography 9.74 s, 5‐point auscultation 18.22 s, and capnography 29.63 s. Conclusion Capnography, ultrasonography, and clinical methods showed comparable sensitivity and specificity for confirming ETT position. However, ultrasonography provided significantly faster confirmation. Clinical Significance Rapid and accurate ETT confirmation is critical in emergency settings, and ultrasonography offers a reliable time‐efficient alternative to conventional techniques.