A Randomized Controlled Trial Comparing Time for Tracheal and Pleural Ultrasonographic Confirmation of the Correct Placement of the Endotracheal Tube in Overweight and Obese Patients.

BACKGROUND

Successful placement of an endotracheal tube (ETT) and its timely confirmation in obese patients is of utmost importance. Chest auscultation might be misleading in the obese. Considering the need for an additional efficient method, the present study compared tracheal and pleural ultrasonography (USG) for confirming ETT placement in overweight and obese patients.

METHODS

A prospective, comparative, randomized, single-blinded study enrolled a total of 64 overweight, obese class I and class II patients aged between 18 and 60 years, American Society of Anesthesiologists grades I or II, scheduled for elective surgeries under general anesthesia with endotracheal intubation. Patients were randomized into two groups of 32 each based on the USG technique used for confirmation of ETT placement. Group T is Tracheal USG, and Group P is Pleural USG. The primary outcome was a comparison of the time required by tracheal and pleural ultrasonography techniques for confirmation of ETT placement, while the secondary outcome was a comparison of the time required by both USG techniques with the time for auscultation and capnographic confirmation of ETT placement.

RESULTS

Tracheal USG took the least time (4.19 ± 0.89 seconds) compared to pleural USG (10.88 ± 1.16 seconds) and proved to be faster. Time taken for auscultation (P < 0.001) was longer than both USG methods, but less than capnography time. Capnographic confirmation took the maximum time when compared to USG and auscultation (P < 0.001).

CONCLUSION

Tracheal USG provides a faster confirmation of endotracheal intubation than pleural USG in overweight and obese patients. Pleural USG has the added advantage of diagnosing endobronchial intubation.