Comparison of End-tidal Capnography, Chest Auscultation, and Upper Airway Ultrasonography for Rapid Confirmation of Endotracheal Tube Placement by Trainees among Patients Requiring Intubation for General Anesthesia

Background: Ensuring proper endotracheal tube (ETT) placement is crucial during general anesthesia. Traditional confirmation methods include capnography and chest auscultation, but each has limitations. Ultrasound (USG) offers real-time visualization of ETT placement, potentially improving confirmation speed and accuracy. Objectives: To compare the feasibility of USG for early detection of esophageal intubation against capnography and chest auscultation in trainees. Methodology: This comparative observational study assessed the time for ETT placement confirmation using USG, capnography, and chest auscultation in 90 patients undergoing general anesthesia. Patients were divided into three groups: USG confirmation (Group A), capnography confirmation using the first or sixth waveform (Group B), and chest auscultation confirmation (Group C). Results: Group A had the fastest confirmation time (32.1 s), followed by Group C (bilateral: 46.97 s), and Group B (6th waveform: 48.23 s). Statistically significant differences were observed between Group A and Group B (6 th waveform), and Group A and Group C (bilateral). Hemodynamic parameters showed significant changes during and after intubation compared to baseline. Conclusions: USG emerged as a faster and potentially more reliable method for ETT placement confirmation compared to capnography and chest auscultation. The real-time visualization offered by USG is valuable for novice trainees, enabling rapid confirmation, and potentially improving patient safety by facilitating early detection of misplacement.