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.