What is the preferred method to confirm endotracheal tube placement?

• A. Capnography is the preferred method to confirm endotracheal tube placement.
• B. Auscultation alone confirms placement.
• C. Chest X-ray is the only definitive method.
• D. Pulse oximetry alone confirms placement.

Answer: (A)

Capnography provides real-time, objective confirmation of tube placement by detecting exhaled carbon dioxide. When the endotracheal tube is in the trachea, CO2 is continuously measured and a characteristic waveform appears, confirming correct placement. If the tube were in the esophagus, CO2 would be absent or markedly diminished, making capnography a rapid and reliable check.

Auscultation, while helpful as a quick bedside check, can be misleading because sounds of air may be heard on both sides of the chest or transmitted from the stomach, especially in noisy or chaotic environments. Chest X-ray can confirm placement, but it takes time and isn’t immediately available at the moment of intubation. Pulse oximetry shows oxygenation status, not tube location, and a patient can have acceptable SpO2 even with esophageal intubation early on or after rapid ventilation changes.

So capnography is preferred because it gives immediate, physiologic confirmation of tracheal tube placement and allows continuous monitoring throughout the airway management process.