Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis
Authors' conclusion
Misting or auscultation have too high a false positive rate to reliably exclude oesophageal intubation and there is insufficient evidence to support the use of 'hang-up' or chest rise.
Study context
- Population
- Patients undergoing tracheal intubation; index clinical tests vs reference standard (capnography, direct vision, bronchoscopy)
- Participants
- 10,654 patients · 49 studies
- Comparison
- Clinical examination tests and the oesophageal detector device vs reference standard for confirming tracheal intubation
- Mistingn = 115
- Lung auscultationn = 217
- Five-point auscultationn = 506
- Oesophageal detector devicen = 3,024
- Outcome
- Diagnostic accuracy (false positive rate) for confirming tracheal intubation
Methodological detailsMethodological quality overall moderate to high, Four databases searched to 28 February 2023, Reference standards: capnography (22 studies), direct vision (10), bronchoscopy (3)
- Methodological quality overall moderate to high
- Four databases searched to 28 February 2023
- Reference standards: capnography (22 studies), direct vision (10), bronchoscopy (3)
Pooled result
As reported in the abstract
False positive rate for confirming tracheal intubation
| Group | False positive rate (95%CI) |
|---|---|
| Misting | 0.69 (0.43-0.87) |
| Lung auscultation | 0.14 (0.08-0.23) |
| Five-point auscultation | 0.18 (0.08-0.36) |
| Oesophageal detector device | 0.05 (0.02-0.09) |
False positive rate (95%CI)
Misting0.69 (0.43-0.87)
Lung auscultation0.14 (0.08-0.23)
Five-point auscultation0.18 (0.08-0.36)
Oesophageal detector device0.05 (0.02-0.09)
Original publication
Clinical tests for confirming tracheal intubation or excluding oesophageal intubation: a diagnostic test accuracy systematic review and meta‐analysis. Anaesthesia. Published 16 June 2023. doi:10.
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