Question

A 30 year old male was intubated for surgery. The best method to confirm the position of Endotracheal tube is

• A. X-ray chest
• B. Auscultation
• C. Capnography
• D. Chest expansion

Hint:

The gold standard for confirming endotracheal tube placement detects a gas that is only present in the airway, not the oesophagus.

Answer 1

The Correct Option is C

Step 1: Understand the clinical problem. After endotracheal intubation, confirming correct tube placement in the trachea (and not in the oesophagus or right main bronchus) is a patient safety priority.

Step 2: Evaluate each method.

• X-ray chest: Can confirm tube position but is not immediately available at the time of intubation; it confirms position after the fact and requires time.
• Auscultation: Useful but can be misleading -- breath sounds may be transmitted from the oesophagus to the lungs, giving false reassurance. Not reliable as the sole method.
• Capnography (end-tidal CO2 monitoring): The gold standard for confirming endotracheal tube placement. CO2 is detected only when the tube is in the airway (trachea/bronchi). Continuous waveform capnography is the most reliable method as oesophageal intubation will not produce a sustained CO2 waveform.
• Chest expansion: Subjective; can be present even with oesophageal intubation due to gastric distension and diaphragmatic movement.

Step 3: Conclusion. Capnography (end-tidal CO2 detection) is the best and most reliable method to confirm endotracheal tube position. It should be used in all intubated patients with adequate tissue perfusion. Answer: Capnography.