What is the gold standard for endotracheal tube placement?

Waveform capnography is considered the gold standard for confirming endotracheal tube placement because it provides real-time analysis of exhaled carbon dioxide. This tool measures the concentration of carbon dioxide in each respiratory cycle, which indicates whether the tube is correctly placed in the trachea or if it is positioned in the esophagus. The presence of consistent, fluctuating waveforms on the capnography monitor during ventilation signifies effective pulmonary gas exchange, confirming that the tube is in the right position.

In contrast, while other methods such as ultrasound can be useful for certain applications, and chest X-rays can provide confirmation of tube placement, they are not as definitive or immediate as waveform capnography. Clinical observation, although important, cannot reliably determine if the tube is in the appropriate location without additional confirmatory methods. Thus, waveform capnography stands out as the most reliable and effective method for this purpose.