Diaphragmatic Ultrasound Is Not Accurate for Identifying Mainstem Intubation

End-tidal carbon dioxide (ET-CO₂) detection is the standard for confirming that an endotracheal tube is in the airway, not in the esophagus, but a chest x-ray is required to determine where the tube is located in the airway. These authors evaluated whether detection of diaphragm movement by ultrasound could distinguish tracheal intubation from mainstem bronchus or esophageal intubation in children.

Investigators enrolled a convenience sample of 127 children (mean age, 6 years) who were emergently intubated in a pediatric emergency department in Cincinnati during a 16-month period. After confirmation of tracheal intubation by ET-CO₂ testing, patients underwent chest radiography, followed by diaphragmatic ultrasonography. Sonographers received…