Airway ultrasound versus capnography to confirm endotracheal intubation: protocol for a systematic review and meta-analysis

Ensuring the proper placement of the endotracheal tube is fundamental to airway management, particularly in high-stakes emergency scenarios where rapid and accurate confirmation of intubation is critical for effective ventilation and the prevention of complications. Traditionally capnography has been the gold standard for confirming intubation. However, in certain situations, like low perfusion or inadequate ventilation, capnography may have limitations. Airway ultrasound has been explored as a possible alternative here because it allows real-time visualization of airway structures and the position of the endotracheal tube. This systematic review aims to compare the accuracy and effectiveness of airway ultrasound versus capnography for confirming endotracheal intubation in clinical settings. This is a protocol for a systematic review and meta-analysis. A comprehensive search will be done in databases such as MEDLINE, EMBASE and Scopus, and clinical trial registries. Quantitative studies published from inception until the date of the final search, conducted among adult patients (18 + years) intubated in emergency, operating, or ICU settings, and published in English will be included. The data extraction will be performed by two independent reviewers. Risk of bias will be assessed using validated methodological appraisal frameworks appropriate to the design of each included study. Certainty of the evidence will be reported according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach and the review will be reported according to PRISMA guidelines. Publication bias will be evaluated using funnel plots. A random-effects meta-analysis will be conducted. The review will evaluate the strengths and weaknesses of both airway ultrasound and capnography. Capnography is widely accepted as gold standard to confirm intubation, but the real-time visualization and bedside applicability of ultrasound are expected to complement its role as a useful adjunct or alternative in routine and challenging scenarios. PROSPERO CRD42024582593