Endotracheal Tube Placement

Endotracheal intubation (ETI) is a potentially lifesaving procedure performed in the out-of-hospital setting. The goal of the intervention is to optimize oxygenation, ventilation, and aid in airway protection from potential aspiration. Complications associated with ETI can lead to significant morbidity and possibly even death. The majority of these risks are caused by the failure to recognize a misplaced or dislodged endotracheal tube (ETT). Waveform capnography is considered the most dependable method for ETT confirmation in the prehospital setting. Additionally, ultrasound appears to be a valuable adjunct, especially in situations where capnography is unavailable or unreliable. The device allows for immediate feedback of ETT placement, and the ability to assess optimal ETT depth and potential underlying lung pathology. Several methods of assessing for correct ETT placement have been described in the literature, including direct tracheal assessment, and the indirect assessment of bilateral lung sliding and diaphragmatic movement associated with ventilation.