Lung ultrasound compared to fiber-optic bronchoscopy in detecting proper endotracheal tube position in intubated patients in the intensive care unit

Abstract

ABSTRACT Background Accidental endobronchial intubation can lead to serious complications in critically ill patients, which can be avoided through early detection and proper positioning of the endotracheal tube. This cross-sectional study estimates lung ultrasound’s sensitivity in detecting the proper position of the endotracheal tube compared to auscultation and fiberoptic bronchoscopy. Methods Sixty intubated adult ICU patients were examined by auscultation, ultrasound, and fiberoptic bronchoscope by three different blinded physicians to detect the position of the ETT (endotracheal, right, and left endobronchial). An ultrasound examination was done by evaluating the lung sliding sign. Statistical analysis included sensitivity, specificity, PPV, and NPV. Results Auscultation showed 64% sensitivity, 100% specificity, 100% positive predictive value, 90.2% negative predictive value, and 91.7% accuracy. Compared to fiberoptic bronchoscopy, lung ultrasound showed 85.7% sensitivity, 100% specificity, 100% positive predictive value, 95.8% negative predictive value, with of 96.7% accuracy. Conclusion Compared to fiberoptic bronchoscopy and auscultation, lung ultrasound has a very high sensitivity for detecting the proper endotracheal tube position.