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© 2008 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 27:785-789 • 0278-4297

Case Series

Point-of-Care Sonographic Detection of Left Endobronchial Main Stem Intubation and Obstruction Versus Endotracheal Intubation

Michael Blaivas, MD, RDMS and James W. Tsung, MD, MPH

Department of Emergency Medicine, Northside Hospital–Forsyth, Cumming, Georgia USA (M.B.); and Pediatric Emergency Services, Bellevue Hospital Center, New York University School of Medicine, New York, New York USA (J.W.T.).

Address correspondence to Michael Blaivas, MD, Department of Emergency Medicine, Northside Hospital–Forsyth, 1200 Northside Forsyth Dr, Cumming, GA 30041 USA. E-mail: blaivas{at}pyro.net

Objective. Determining the correct position of endotracheal tubes in critically ill patients may be complicated by external factors such as noise, body habitus, and the need for ongoing resuscitation. Multiple detection techniques have been developed to determine the correct endotracheal tube position, recently including the use of sonography to evaluate lung expansion and diaphragmatic excursion. These techniques have also been applied to diagnosis of right endobronchial main stem intubation, which may be confused with a unilateral pneumothorax in some cases. Methods. We describe the sonographic findings in a case series of endobronchial main stem intubations and obstruction, highlighting the utility of this sonographic application. Previous literature and future applications are discussed. Results. Sonographic detection of the sliding lung sign, the lung pulse, and diaphragmatic excursion can accurately detect main stem bronchial intubation as well as bronchial obstruction. Conclusions. Clinical use of lung sonography may decrease the need for chest radiography and may allow more rapid diagnosis of main stem intubation and bronchial obstruction.

Key Words: airway management • airway obstruction • emergency sonography • endotracheal intubation • main stem intubation

Abbreviations: ED, emergency department • EMS, emergency medical services • ETT, endotracheal tube • FAST, focused assessment with sonography for trauma • ICU, intensive care unit

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Copyright © 2008 by the American Institute of Ultrasound in Medicine.