Focus on POCUS: Identification of Early Successful Intubation by Point-of-Care Ultrasound Versus End-Tidal Carbon Dioxide: A Prospective Comparative Study.

Abstract

Objective: Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO₂) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explored the time-sensitive early recognition of successful endotracheal intubation by comparing ultrasound and etCO₂ monitoring.

Methods: The study included 104 patients who were posted for elective surgery under general anaesthesia requiring endotracheal intubation. The time from removal of the face mask to ultrasound visualization of flutter in the trachea was compared with that of the appearance of six consecutive capnography waveforms following endotracheal intubation.

Results: Ultrasound was a faster tool for recognizing successful endotracheal intubation [(21.63±7.38) seconds] compared with capnography [(40.62±7.93) seconds].

Conclusion: eCO₂ requires more time for 6 continuous waveforms to confirm successful intubation and has a false positive rate. Supplementing the gold standard etCO₂ with ultrasound is faster and reliable in patients with low pulmonary blood flow without needing positive pressure ventilation, such as during cardiopulmonary resuscitation, in high-risk emergency intubations, such as in trauma, or in difficult airways where intubation can be confirmed in real time. Ultrasound is a reliable and faster tool for the early identification of successful endotracheal intubation than end-tidal carbon dioxide.