![]() (Bhende and Thompson 1995 Zechner and Breitkreutz 2011) In one prospective study, the sensitivity of this device in detecting proper endotracheal placement in cardiac arrest patients was only 85% (Takeda et al. These devices start at baseline color when minimal carbon dioxide is present and undergo gradual color change with increasing carbon dioxide concentration (O’Flaherty 1994).Ĭapnography is less reliable in the setting of cardiac arrest patients and can be affected by low cardiac output, low pulmonary flow, airway obstruction, or epinephrine use in addition to its unavailability outside the operating theater. Colorimetric carbon dioxide detectors are considered a simplistic mainstream capnography that contains a pH-sensitive chemical marker that is prone to color changes with each inspiration and expiration representing changes in the concentration of carbon dioxide. Analyzers utilize infrared, mass or Raman spectra, or photoacoustic spectra technology (Block Jr and McDonald 1992 O’Flaherty 1994). The mainstream analyzer deploys a sampling window in the ventilation circuits, whereas a sidestream analyzer samples gas from the ventilator circuit, and the analysis occurs away from the ventilator circuit. There are two types of sampling techniques in capnographic devices: mainstream or sidestream. The 2010 American Heart Association (AHA) Guidelines for cardiopulmonary resuscitation (CPR) guidelines and Emergency Cardiovascular Care (ECC) recommended quantitative waveform capnography for verifying the correct placement of an ETT as the gold standard (Neumar et al. The end-tidal carbon dioxide (ETCO 2) detector used in the operating room is considered a standard of care by anesthesiologists (Ginsburg 1993).Ĭapnography refers to the measurement of carbon dioxide in the respiratory gases of mechanically ventilated patients. Misplacement of the ETT can lead to devastating, preventable morbidity, and mortality. Unfortunately, clinical signs are not fully sensitive to diagnose esophageal intubation and even risky to rely on alone thus, other techniques to confirm the proper site of the endotracheal tube (ETT) are devastatingly necessary (Clyburn and Rosen 1994). However, these disadvantages can be easily overruled and the benefits from both tools overweigh their disadvantages.Įndotracheal intubation is essential for optimal airway control during general anesthesia or resuscitation of critically ill patients. Conclusionīoth tools are fast, effective, reliable, and accurate with many advantages and few disadvantages including the need for training on ultrasound practice and air-filled stomach in colorimetric capnography. Although there were higher sensitivity and accuracy of colorimetric capnography than real-time tracheal ultrasound, the p value between the two groups was 0.462. Comparing both groups according to their diagnostic performance for detecting the correct position of the ETT inserted showed the diagnostic sensitivity, specificity, and accuracy of real-time tracheal ultrasound vs colorimetric capnography (93.8%, 66.7%, and 91.4% VS 97%, 50%, and 94.3% respectively). Group A in which patients’ ETT position was confirmed by real-time tracheal ultrasound and group B in which patients’ ETT position was confirmed by colorimetric capnography. Patients were divided randomly and equally into two groups (35 patients each). ![]() ![]() This study carried out on eligible seventy patients undergoing general anesthesia. We aimed to compare two different techniques (tracheal real-time ultrasound vs colorimetric capnography) as point of care tools for confirmation of correct endotracheal tube position. Real-time tracheal ultrasound allows for the dynamic observation of tube passage through the trachea or the esophagus, providing immediate confirmation of placement prior to any ventilation attempts with reported sensitivity/specificity of 100% for adult patients in the operating room. Colorimetric carbon dioxide detectors are considered a simplistic mainstream capnography that contains a pH-sensitive chemical marker that is prone to color change with ventilation. Misplacement of the endotracheal tube (ETT) can lead to devastating, preventable morbidity and mortality. Endotracheal intubation is essential for optimal airway control during general anesthesia or resuscitation of critically ill patients. ![]()
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