Open Access

Comments to Role of upper airway ultrasound in airway management

Journal of Intensive Care20175:10

DOI: 10.1186/s40560-016-0204-x

Received: 26 November 2016

Accepted: 27 December 2016

Published: 13 January 2017

Abstract

Tracheal ultrasound can be an alternative diagnostic tool in airway management, besides traditional confirmatory methods such as capnography and auscultation. The standard image is a hyperechoic air–mucosa (A–M) interface with a reverberation artifact posteriorly (comet-tail artifact). If the second A–M interface appears, which we call a “double-tract sign,” esophageal intubation is considered.

Keywords

Ultrasound Airway Air–mucosa interface Double-tract sign

With great interest, I read the article by Osman et al., entitled “Role of upper airway ultrasound (US) in airway management” [1]. The authors reviewed thoroughly for the various US applications for the upper airway, including prediction of endotracheal tube (ETT) size, difficult laryngoscopy, airway device placement and depth, percutaneous cricothyroidotomy, prediction of post-extubation stridor, and evaluation of the epiglottis.

Auscultation, waveform capnography, and chest X-ray are traditional methods for airway confirmation at critical or emergency situations. Although capnography is considered as the most reliable method, it may be biased by low cardiac output, low pulmonary flow, or epinephrine use in cardiac arrest patients [2]. US can be an alternative diagnostic tool for these conditions.

The standard image of tracheal US is a hyperechoic air–mucosa (A–M) interface with a reverberation artifact posteriorly (comet-tail artifact), surrounded by the thyroid glands. The esophagus is located at the posterior area of the left lobe of the thyroid gland [1]. Tracheal intubation is identified if only one A–M interface is present with one comet-tail artifact. If the second A–M interface appears, which we call a “double-tract sign”, esophageal intubation is diagnosed [3, 4]. However, in the session of the ETT confirmation, the authors suggested that the “double-tract” or “double-lumen” sign was present when ETT position was in the trachea. There may be some misunderstandings.

Notes

Abbreviations

A–M: 

Air–mucosa interface

ETT: 

Endotracheal tube

US: 

Ultrasound

Declarations

Acknowledgements

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Competing interests

The author declares that he/she has no competing interests.

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Authors’ Affiliations

(1)
Department of Emergency Medicine, College of Medicine, National Taiwan University and National Taiwan University Hospital

References

  1. Osman A, Sum KM. Role of upper airway ultrasound in airway management. J Intensive Care. 2016;4:52.View ArticlePubMedPubMed CentralGoogle Scholar
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  3. Chou HC, Tseng WP, Wang CH, Ma MH, Wang HP, Huang PC, et al. Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation. 2011;82:1279–84.View ArticlePubMedGoogle Scholar
  4. Chou HC, Chong KM, Sim SS, Ma MH, Liu SH, Chen NC, et al. Real-time tracheal ultrasonography for confirmation of endotracheal tube placement during cardiopulmonary resuscitation. Resuscitation. 2013;84:1708–12.View ArticlePubMedGoogle Scholar

Copyright

© The Author(s). 2017

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