Transtracheal Ultrasound as a Preventive Tool for ETT Related Adverse Events and Malpositioning in the ICU

Document Type

Journal Article

Publication Date

1-9-2025

Journal

Journal of intensive care medicine

DOI

10.1177/08850666241296523

Keywords

adverse events; chest radiograph; clinical research; critical care; endotracheal intubation; imaging utilization; intensive care unit; mechanical ventilation; monitoring; patient monitoring

Abstract

INTRODUCTION: Endotracheal tube (ETT) malpositioning can result in a myriad of complications. Daily chest radiographs (CXR) is the gold standard in monitoring these complications. Point-of-care transtracheal ultrasound (TTUS) is an emerging imaging modality for ETT positioning. We compared ETT malpositioning related adverse events and diagnostic accuracy of ETT malpositioning of a combined TTUS and CXR surveillance protocol to CXR alone. METHODS: We performed a randomized control trial of mechanically ventilated patients in an academic multidisciplinary ICU. In the intervention group, the clinical team was provided the results of the TTUS with CXR results to aid in clinical decision making. In the control group only CXR results were used. Adverse events included bronchial migration, vocal cord herniation, balloon rupture, unplanned extubation, and the development of aspiration pneumonia. Data was analyzed via Fisher's Exact Test. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were calculated.

Department

Emergency Medicine

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