266: Confirmation of Ventilation and Intubation by Determination With Ultrasonography (COVID-US Study)

INTRODUCTION: Chest radiography remains the gold standard for confirming endotracheal tube positioning, however, ultrasonography can be a useful alternative We explore the feasibility of a combination of tracheal and thoracic ultrasonography to confirm tracheal intubation in the critically ill METHODS: We studied 118 patients from 4 different academic and community hospitals in the US from February 2019 to May 2020 Eligible patients were adults requiring intubation and intensive care Patient demographics, COVID-19 status, and intubation characteristics were recorded Bedside ultrasonography was performed to confirm and adjust endotracheal tube position We compared adequate positioning as obtained by ultrasonography with the next occurring chest radiograph for agreement RESULTS: Among 118 patients, median age was 66 years (IQR 56, 73), body mass index 28 (IQR 25, 34), and 36 4 % were females Nearly 40% patients were positive or under the suspicion of COVID-19 during intubation attempts Using the COVID-US protocol, one esophageal (0 9%) and 5 (4 2%) main stem intubations were detected 97 5% of final endotracheal tube positions confirmed by ultrasound were in concordance with the next occurring chest radiograph, with only 3 (2 5%) requiring minor post chest radiograph adjustments CONCLUSIONS: A protocolized approach utilizing bedside ultrasonography can be used to confirm tracheal intubation and adjust tube positioning in the critically ill This approach is easily applicable, safe, and comparable to chest radiography This can be used as an alternative or adjunct when chest radiography is not available or ideal, routine intensive care, out-of-hospital settings, and to minimize exposure in COVID-19