Table 2.
Summary of studies on the use of ultrasound to confirm endotracheal tube placement.
| Author, Date, and Country | Setting | Patient Population | Study Type | Sample Size | Outcomes | Key Results |
|---|---|---|---|---|---|---|
| Abdelrahman, 2020, Egypt [68] | OR | Adult | Prospective, Randomized | 70 | Ultrasound and Capnography | 93.8% sensitive, 66.7% specific, 91.4% accurate |
| Afzalimoghaddam, 2019, Iran [69] | ED | Adult | Prospective, observational | 90 | Ultrasound and Capnography | 100% sensitive, 100% specific, US is easily taught and learned, US is an effective method for confirming ET tube placement in ED and does not require interruption of chest compressions |
| Arafa, 2018, Egypt [70] | OR | Adult | Prospective observational | 107 | Ultrasound, Capnography, and Auscultation | 97% sensitive, 71.4% specific |
| Arya, 2018, USA [71] | ICU | Adult | Prospective observational | 75 | Ultrasound and Capnography | 83% sensitive, 100% specific, 100% PPV, 97% NPV |
| Chen, 2018, China [72] | OR | Adult | Prospective case-control | 105 | Ultrasound and Direct laryngoscopy | 100% sensitive, 100% specific, 100% accurate, allows proper positioning of ETT cuff and reduces vocal cord injury after intubation |
| Chen, 2020, China [73] | ICU | Adult | Prospective observational | 118 | Ultrasound and Fiberoptic Bronchoscopy | 75% sensitive, 100% specific, 100% PPV, 97.2% NPV, allowed for rapid clinical decision making |
| Chou, 2011, Taiwan [9] | ED | Adult | Prospective observational | 112 | Ultrasound and Capnography | 98.2% accuracy, 98.9% sensitive, 94.1% specific |
| Chou, 2013, Taiwan [74] | ED | Adult (cardiac arrest) | Prospective observational | 89 | Ultrasound, Capnography, and Auscultation | 100% sensitive, 85.7% specific |
| Chowdhury, 2020, India [75] | OR | Adult | Prospective, single blinded clinical trial | 120 | Ultrasound, Capnography, and Auscultation | 100% sensitive, 100% specific, US was fastest method of determining ET intubation, allowed for rapid correction of errors in placement |
| Inangil, 2018, Turkey [76] | OR | Adult | Prospective, paired, single blind | 56 | Ultrasound and Capnography | 95.75% sensitive, 100% specific, faster than capnography |
| Kabil, 2018, Saudi [77] | ICU | Adult | Prospective observational | 40 | Ultrasound and Bronchoscopy | 97.2% sensitive, 100% specific, rapidly informed decision making |
| Kad, 2018, India [78] | OR | Adult | Prospective crossover | 100 | Ultrasound and Auscultation | 88.46% sensitive, 100% specific when “lung sliding” sign is visualized on US, superior to auscultation alone |
| Lahham, 2017, USA [79] | ED | Adult | Prospective cohort | 72 | Ultrasound and Capnography | 98.5% Sensitive, 75% specific |
| Masoumi, 2017, Iran [80] | ED | Adult | Prospective observational | 100 | Ultrasound and Capnography | 98.9% sensitive, 100% specific for US (TRUE method) to detect ETT |
| Mousavi, 2022, Iran [81] | ED | Adult | Cross-sectional | 66 | Ultrasound and Capnography | 98% specific, 66% sensitive, suprasternal view better than subxiphoid for placement confirmation |
| Patil, 2019, India [82] | ICU | Adult | Prospective observational | 89 | Ultrasound and Capnography | 96% sensitive, 100% specific; allowed for real time detection |
| Rahmani, 2017, Iran [83] | ED | Adult | Descriptive analytic | 75 | Ultrasound and Capnography | “Snowstorm” sign was 100% sensitive and 100% specific for detecting ETT |
| Rahul, 2016, USA [84] | ICU | Adult | Prospective, double blind | 20 | Ultrasound, Capnography, and Auscultation | 100% accuracy, Outperformed gold standard, able to detect right main stem intubation |
| Sethi, 2019, India [85] | OR | Adult | Prospective, randomized, observational | 90 | Ultrasound, Capnography, and Auscultation | 100% accuracy, faster than capnography |
| Thomas, 2017, India [86] | ED | Adult | Prospective cohort study | 100 | Ultrasound and Capnography | 97.89% sensitive, 100% specific for diagnosis of esophageal intubation, equal to capnography but quicker |
| Yang, 2017, China [87] | OR | Adult | Prospective, randomized, double blinded | 93 | Ultrasound and Capnography | 100% sensitive, 88.9% specific for US localization of tracheal intubations |
| Zamani, 2017, Iran [88] | ED | Adult | Prospective, cross sectional | 150 | Ultrasound, Auscultation, Direct Laryngoscopy, ETT aspiration, and Pulse Oximetry | 96% sensitive, 88% specific, 98% PPV, 78% NPV for tracheal US in ETT confirmation |
| Zamani, 2018, Iran [89] | ED | Adult trauma | Prospective, single blind | 100 | Ultrasound and Capnography | 97.9% sensitive, 83.3% specific |
Abbreviations: ED, emergency department; ETT, endotracheal tube; ICU, intensive care unit; NPV, negative predictive value; OR, operating room; PPV, positive predictive value; TRUE, tracheal rapid ultrasound exam; US, ultrasound.