Replacing the stethoscope with ultrasound identification of lung sliding to confirm correct endotracheal tube placement for COVID19 patients - time for a paradigm shift?

Dîrzu, Dan Sebastian

Stethoscopes are well known to have the potential to spread virulent pathogens (Maki 2014) and in the ICU settings they seem to have an even more increased role(Thapa and Sapkota 2017). The current pandemic of COVID19 disease involves severe risks for the healthcare provider involved in initiating invasive ventilation for ARDS patients. Medical staff gets infected every day and a lot of colleagues already died due to the novel disease. As surface contamination is one of the common ways involved in disease spreading, the stethoscope, a ubiquity tool that needs to be in contact with both infected patient and the cephalic extremity of the health care practitioner may have a key role. Auscultation of both lungs with the stethoscope to differentiate between tracheal and bronchial intubation is still the standard of care in all the intubation protocols all around the world. The preoccupation to include the ultrasound as a tool for airway management is not new (Garg 2015) and ultrasound was showed to have better sensibility and specificity than auscultation (Ramsingh et al. 2016).