Evaluation of real-time tracheal ultrasound versus colorimetric capnography as a point of care tool for confirmation of endotracheal intubation: a randomized controlled study

Endotracheal intubation is essential for optimal airway control during general anesthesia or resuscitation of critically ill patients. Misplacement of the endotracheal tube (ETT) can lead to devastating, preventable morbidity and mortality. Colorimetric carbon dioxide detectors are considered a simplistic mainstream capnography that contains a pH-sensitive chemical marker that is prone to color change with ventilation. Real-time tracheal ultrasound allows for the dynamic observation of tube passage through the trachea or the esophagus, providing immediate confirmation of placement prior to any ventilation attempts with reported sensitivity/specificity of 100% for adult patients in the operating room. We aimed to compare two different techniques (tracheal real-time ultrasound vs colorimetric capnography) as point of care tools for confirmation of correct endotracheal tube position. This study carried out on eligible seventy patients undergoing general anesthesia. Patients were divided randomly and equally into two groups (35 patients each). Group A in which patients’ ETT position was confirmed by real-time tracheal ultrasound and group B in which patients’ ETT position was confirmed by colorimetric capnography. Comparing both groups according to their diagnostic performance for detecting the correct position of the ETT inserted showed the diagnostic sensitivity, specificity, and accuracy of real-time tracheal ultrasound vs colorimetric capnography (93.8%, 66.7%, and 91.4% VS 97%, 50%, and 94.3% respectively). Although there were higher sensitivity and accuracy of colorimetric capnography than real-time tracheal ultrasound, the p value between the two groups was 0.462. Both tools are fast, effective, reliable, and accurate with many advantages and few disadvantages including the need for training on ultrasound practice and air-filled stomach in colorimetric capnography. However, these disadvantages can be easily overruled and the benefits from both tools overweigh their disadvantages.