What is the single most reliable method for confirming the correct placement of an endotracheal tube?

The single most reliable method for confirming the correct placement of an endotracheal tube is quantitative waveform capnography. This technique involves measuring the concentration of carbon dioxide in exhaled air, providing direct evidence that the endotracheal tube is positioned correctly within the trachea and not in the esophagus. When a tube is properly placed, the capnography waveform will show a consistent presence of CO2 with a characteristic slope, indicating effective ventilation.

This method is considered superior because it is both specific and sensitive to detecting ventilation. Unlike pulse oximetry, which primarily indicates oxygen saturation and can provide misleading information if a patient is in an inadequate breathing state or if perfusion is poor, capnography gives real-time feedback on the exhalation of CO2, which is a direct product of effective respiration.

While visual confirmation through the laryngoscope can provide some assurance regarding tube placement, it does not guarantee that the tube is correctly positioned within the trachea, as it is possible to visualize the larynx without accurately assessing tube placement. End-tidal CO2 detection, while helpful, is less specific than quantitative waveform capnography, especially in certain circumstances such as low cardiac output states.

Thus, quantitative waveform cap