Can the fluctuation observed in the endotracheal tube with compression applied to the epigastric region be used as a confirmation method for endotracheal intubation?

Abstract

Background: The traditional methods are mostly used to detect tracheal localization and to exclude esophageal localization. Therefore, the aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube. Methods: Out-of-hospital ETE was performed by experienced paramedics working in the emergency ambulance service, while ETE in the emergency department was performed by emergency medicine residents or emergency medicine specialists with at least 2 years of emergency department experience. Epigastric compression was performed by applying pressure to the epigastric region at least three times (in 5 sec) with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask. Immediately after ETI was performed, Ultrasonography (USG) was performed as the gold standard confirmation method. If a double path sign was observed and the pleural sliding motion was not seen, it was considered unsuccessful. Results: A total of 78 patients were included in the study (an equal number of successful and unsuccessful ETE applications). Approximately 59% (n=46) of the patients were female, median age was 73 years (64-80), and 22(28.2%) patients were intubated due to traumatic etiology. The specificity and sensitivity of epigastric fluctuation for esophageal intubations were 83.33% and 60%, respectively. The positive predictive value was 92.31%, and the negative predictive value was 38.46%. Epigastric auscultation airflow sound had a specificity of 86.96% and a sensitivity of 65.45% for esophageal intubation. Conclusion: Although the fluctuation that occurs in the tube with epigastric compression is not as sensitive and specific as USG, it is a better method than lung auscultation.