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Ariff S, Ali KQ, Tessaro MO, Ansari U, Morris S, Soofi SB, Merali HS. Diagnostic accuracy of point-of-care ultrasound compared to standard-of-care methods for endotracheal tube placement in neonates. Pediatr Pulmonol 2022; 57:1744-1750. [PMID: 35501297 DOI: 10.1002/ppul.25955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is a valuable tool to determine endotracheal tube (ETT) placement; however, few studies have compared it with standard confirmation methods. We evaluated the diagnostic accuracy of POCUS and time-to-interpretation for correct identification of tracheal versus esophageal intubations compared to a composite of standard-of-care methods in neonates. METHODS A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi, Pakistan. All required intubations were performed as per NICU guidelines. The clinical team simultaneously determined the ETT placement using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by POCUS. In addition, the clinical team was blinded to the POCUS images. Timings were recorded for each method by independent study staff. RESULTS A total of 348 neonates were enrolled in the study. More than half (58%) of intubations were in an emergency scenario. POCUS user interpretation showed 100% sensitivity and 94% specificity using an expert as the reference standard. We found a 99.4% agreement (Kappa: 0.96; p < 0.001). Diagnostic accuracy of POCUS compared with at least two standard-of-care methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9% agreement (Kappa:0.93; p < 0.001). The median time required for POCUS interpretation was 3.0 (interquartile range [IQR] 3.0-4.0) seconds for tracheal intubation. The time recorded for auscultation and capnography was 6.0 (IQR 5.0-7.0) and 3.0 (IQR 3.0-4.0), respectively. CONCLUSION POCUS is a rapid and reliable method of identifying ETT placement in neonates. Early and correct identification of airway management is critical to save lives and prevent mortality and morbidity.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khushboo Q Ali
- Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Mark O Tessaro
- Pediatric Emergency Medicine, Emergency Point-of-Care Ultrasound Program, The Hospital for Sick Children, Toronto, Canada
| | - Uzair Ansari
- Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaun Morris
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Hasan S Merali
- Pediatric Emergency Medicine, McMaster Children's Hospital, Hamilton, Canada
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Congedi S, Savio F, Auciello M, Salvadori S, Nardo D, Bonadies L. Sonographic Evaluation of the Endotracheal Tube Position in the Neonatal Population: A Comprehensive Review and Meta-Analysis. Front Pediatr 2022; 10:886450. [PMID: 35722478 PMCID: PMC9201277 DOI: 10.3389/fped.2022.886450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Endotracheal intubation in neonates is challenging and requires a high level of precision, due to narrow and short airways, especially in preterm newborns. The current gold standard for endotracheal tube (ETT) verification is chest X-ray (CXR); however, this method presents some limitations, such as ionizing radiation exposure and delayed in obtaining the radiographic images, that point of care ultrasound (POCUS) could overcome. Primary Objective To evaluate ultrasound efficacy in determining ETT placement adequacy in preterm and term newborns. Secondary Objective To compare the time required for ultrasound confirmation vs. time needed for other standard of care methods. Search Methods A search in Medline, PubMed, Google Scholar and in the Cochrane Central Register of Controlled Trials (CENTRAL) was performed. Our most recent search was conducted in September 2021 including the following keywords: "newborn", "infant", "neonate", "endotracheal intubation", "endotracheal tube", "ultrasonography", "ultrasound". Selection Criteria We considered randomized and non-randomized controlled trials, prospective, retrospective and cross-sectional studies published after 2012, involving neonatal intensive care unit (NICU) patients needing intubation/intubated infants and evaluating POCUS efficacy and/or accuracy in detecting ETT position vs. a defined gold-standard method. Three review authors independently assessed the studies' quality and extracted data. Main Results We identified 14 eligible studies including a total of 602 ETT evaluations in NICU or in the delivery room. In about 80% of cases the gold standard for ETT position verification was CXR. Ultrasound was able to identify the presence of ETT in 96.8% of the evaluations, with a pooled POCUS sensitivity of 93.44% (95% CI: 90.4-95.75%) in detecting an appropriately positioned ETT as assessed by CXR. Bedside ultrasound confirmation was also found to be significantly faster compared to obtaining a CXR. Conclusion POCUS appears to be a fast and effective technique to identify correct endotracheal intubation in newborns. This review could add value and importance to the use of this promising technique.
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Affiliation(s)
- Sabrina Congedi
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Federica Savio
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padua, Italy
| | - Maria Auciello
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Sabrina Salvadori
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padua, Italy
| | - Daniel Nardo
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padua, Italy
| | - Luca Bonadies
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
- Neonatal Intensive Care Unit, Department of Woman's and Child's Health, Padova University Hospital, Padua, Italy
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Sandig J, Bührer C, Czernik C. [Evaluation of the Endotracheal Tube by Ultrasound in Neonates]. Z Geburtshilfe Neonatol 2022; 226:160-166. [PMID: 35114723 DOI: 10.1055/a-1732-7867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The reliable evaluation of a correctly placed endotracheal tube is an essential challenge in neonatology. Point-of-care ultrasound is an emerging method to address this concern with the following advantages: less time-consuming, no exposure to radiation, less staff-intensive, and high tolerability by the patients. This article focuses on the evaluation of the clinical application of point-of-care ultrasound to examine the position of the endotracheal tube with regard to visualization, consistency compared to the chest X-ray, and the level of training to obtain sufficient results. We identified nine studies relevant to these questions. The visualization of the endotracheal tube by using point-of-care ultrasound is highly effective. The assessment of a correctly placed endotracheal tube is comparable to the results of a chest X-ray. The technique is suitable for any examiner with previous ultrasound experience. Future applications such as emergency intubations, implementation in the standard care of extremely low birth weight preterm babies, and use in low-resource settings could be promising. This article offers a practical guideline to promote the level of awareness and the clinical application.
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Affiliation(s)
- Jan Sandig
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Bührer
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Christoph Czernik
- Klinik für Neonatologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) is an emerging clinical tool in the neonatal intensive care unit (NICU). Recent literature describing the use of POCUS for various applications in the NICU has garnered increased interest among neonatologists. RECENT FINDINGS Diagnostic applications for POCUS in the NICU include the evaluation and serial monitoring of common pulmonary diseases, hemodynamic instability, patent ductus arteriosus (PDA), persistent pulmonary hypertension of the newborn (PPHN), necrotizing enterocolitis (NEC), and intraventricular hemorrhage (IVH), among others. Procedural applications include vascular access, endotracheal intubation, lumbar puncture, and fluid drainage. SUMMARY Experience with POCUS in the NICU is growing. Current evidence supports the use of POCUS for a number of diagnostic and procedural applications. As use of this tool increases, there is an urgent need to develop formal training requirements specific to neonatology, as well as evidence-based guidelines to standardize use across centers.
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Takeuchi S, Arai J, Nagafuji M, Hinata A, Kamakura T, Hoshino Y, Yukitake Y. Ultrasonographic confirmation of endotracheal intubation in extremely low birthweigh infants - secondary publication. Pediatr Int 2020; 62:175-179. [PMID: 31785124 DOI: 10.1111/ped.14069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 10/04/2019] [Accepted: 11/27/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the usefulness of ultrasonography (US) for confirmation of endotracheal tube (ETT) placement during resuscitation in extremely low birthweight (ELBW) infants. METHODS We conducted a retrospective review of the medical records of ELBW infants in whom ETT position was verified using US between June 2016 and September 2017. We investigated the backgrounds of the patients and US investigators, and the time required for the detection of exhaled carbon dioxide using the colorimetric method and US. RESULTS Eleven ELBW infants were evaluated using US by four neonatologists. The median duration required to determine the ETT position by the colorimetric method and US were 11 s and 3 s, respectively. In six ELBW infants, we were able to verify the ETT position more rapidly using US than using the colorimetric method, and were able to perform prompt resuscitation. Unnecessary reintubations were avoided in three ELBW infants. CONCLUSION Ultrasonography allowed the swift confirmation of the tracheal intubations. The colorimetric method yielded false negative results; in such cases, unnecessary reintubation could have been avoided if US was used. We assessed the mechanism of false negative results and performed appropriate resuscitation.
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Affiliation(s)
- Syusuke Takeuchi
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan.,Department of Pediatrics, University of Tsukuba Hospital, Mito, Japan
| | - Junichi Arai
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Motomichi Nagafuji
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan.,Department of Pediatrics, University of Tsukuba Hospital, Mito, Japan
| | - Ayako Hinata
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Tae Kamakura
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Yusuke Hoshino
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
| | - Yoshiya Yukitake
- Department of Neonatology, Ibaraki Children's Hospital, Mito, Japan
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Merali HS, Tessaro MO, Ali KQ, Morris SK, Soofi SB, Ariff S. A novel training simulator for portable ultrasound identification of incorrect newborn endotracheal tube placement - observational diagnostic accuracy study protocol. BMC Pediatr 2019; 19:434. [PMID: 31722685 PMCID: PMC6852924 DOI: 10.1186/s12887-019-1717-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children. Methods This will be an observational diagnostic accuracy study consisting of two phases and conducted at the Aga Khan University Hospital in Karachi, Pakistan. In phase 1, neonatal health care providers that currently perform standard-of-care methods for ETT localization, regardless of experience in portable ultrasound, will undergo a two-hour training session. During this session, providers will learn to detect tracheal vs. esophageal ETTs using POCUS. The session will consist of a didactic component, hands-on training with a novel intubation ultrasound simulator, and practice with stable, ventilated newborns. At the end of the session, the providers will undergo an objective structured assessment of technical skills, as well as an evaluation of their ability to differentiate between tracheal and esophageal endotracheal tubes. In phase 2, newborns requiring intubation will be assessed for ETT location via POCUS, at the same time as standard-of-care methods. The initial 2 months of phase 2 will include a quality assurance component to ensure the POCUS accuracy of trained providers. The primary outcome of the study is to determine the accuracy of neck POCUS for ETT location when performed by neonatal providers with focused POCUS training, and the secondary outcome is to determine whether neck POCUS is faster than standard-of-care methods. Discussion This study represents the first large investigation of the benefits of POCUS for ETT confirmation in the sickest newborns undergoing intubations for respiratory support. Trial registration ClinicalTrials.gov Identifier: NCT03533218. Registered May 2018.
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Affiliation(s)
- Hasan S Merali
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, 1280 Main Street West, HSC-2R104, Hamilton, ON, L8S 4K1, Canada
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Emergency Point-of-Care Ultrasound Program, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Khushboo Q Ali
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shaun K Morris
- Division of Infectious Diseases and Centre for Global Child Health, Hospital for Sick Children, Department of Pediatrics Faculty of Medicine, 555 University Avenue, Toronto, ON, M5G1X8, Canada
| | - Sajid B Soofi
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan
| | - Shabina Ariff
- Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Current Concepts in the Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Sharma D, Tabatabaii SA, Farahbakhsh N. Role of ultrasound in confirmation of endotracheal tube in neonates: a review. J Matern Fetal Neonatal Med 2017; 32:1359-1367. [PMID: 29117819 DOI: 10.1080/14767058.2017.1403581] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Tracheal intubation (TI) is a commonly done procedure in neonatal intensive care unit and delivery room during resuscitation. The confirmation of endotracheal tube (ETT) position should be done quickly as tube malposition is associated with various serious adverse outcomes like hypoxemia, right upper lobe collapse, atelectasis, air leak syndromes and esophageal intubation. ETT position can be confirmed by various methods like clinical sign, chest radiography, capnography, external digital tracheal palpation, ultrasonography (USG), respiratory function monitor, video-laryngoscope and fiberoptic devices. The current gold standard test to confirm ETT position is a chest radiograph, but it has many fallacies thus presently there is the need for a modality that helps in detection of endotracheal intubation and tube position with minimal complications. USG has been used in adult and pediatric population for detecting ETT position but there are very less studies in neonates. In this review, we analyze all the published studies, case reports and personal experiences that have sought the use of USG in neonatal population for detection of ETT position.
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Affiliation(s)
- Deepak Sharma
- a Department of Neonatology , National Institute of Medical Sciences , Jaipur , India
| | - Seyyed Ahmad Tabatabaii
- b Department of Pulmonology , Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Nazanin Farahbakhsh
- b Department of Pulmonology , Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
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Dong F, Zhu C, Xu H, Wang J, Zhu Y, Fan Q, Huang J, Lei W. Measuring Endotracheal Tube Depth by Bedside Ultrasound in Adult Patients in an Intensive Care Unit: A Pilot Study. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1163-1170. [PMID: 28318890 DOI: 10.1016/j.ultrasmedbio.2017.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 01/14/2017] [Accepted: 01/25/2017] [Indexed: 06/06/2023]
Abstract
The aim of the study described here was to evaluate the feasibility and accuracy of measuring endotracheal tube (ETT) depth with ultrasound in adult patients in an intensive care unit (ICU). The distance between the upper margin of the cuff and the upper margin of the aortic arch (Duc-ua) of 67 ICU patients was measured by ultrasound, and the time of measurement was recorded. The level of agreement between the distance between the tip of the ETT and the carina (Dtt-c) measured by ultrasound (U-Dtt-c) and Dtt-c measured by bronchoscopy (B-Dtt-c) was assessed using linear regression and a Bland-Altman plot. There was a significant correlation between B-Dtt-c and U-Dtt-c (r = 0.844, p < 0.001). Also, the Bland-Altman plot revealed strong agreement between B-Dtt-c and U-Dtt-c. The time it took to measure ETT depth by ultrasound was 33.91 ± 5.43 s. In conclusion, bedside ultrasound provides a novel and convenient method for measuring the depth of ETT in ICU patients.
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Affiliation(s)
- Fenglin Dong
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Canhong Zhu
- Department of Respiratory Medicine, Children's Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huiwen Xu
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Jiajia Wang
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yehan Zhu
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qingmin Fan
- Department of Ultrasound, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Jian'an Huang
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wei Lei
- Department of Respiratory Medicine, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
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Najib K, Pishva N, Amoozegar H, Pishdad P, Fallahzadeh E. Ultrasonographic confirmation of endotracheal tube position in neonates. Indian Pediatr 2016; 53:886-888. [DOI: 10.1007/s13312-016-0953-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bedside Ultrasound for Tracheal Tube Verification in Pediatric Emergency Department and ICU Patients: A Systematic Review. Pediatr Crit Care Med 2016; 17:e469-e476. [PMID: 27487913 DOI: 10.1097/pcc.0000000000000907] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Improper placement of the tracheal tube during intubation can lead to dangerous complications, and bedside ultrasound has been proposed as a method of quickly and accurately identifying tube placement. Recent studies in adults have found it to be accurate, but its applicability in pediatric patients is unclear. This systematic review aims to describe the current available data on the accuracy and feasibility of bedside ultrasound for tracheal tube placement in children. DATA SOURCES OVID MEDLINE and EMBASE. STUDY SELECTION Available articles on bedside neck or lung/diaphragm ultrasound for confirmation of tracheal tube placement in children through December 2015. DATA EXTRACTION Two reviewers screened studies for eligibility and abstracted data independently. The quality of selected articles was evaluated using Quality Assessment of Diagnostic Accuracy Studies statement. DATA SYNTHESIS A total of nine articles were identified: one study using neck ultrasound, two using lung/diaphragmatic ultrasound, one with both, and five studies looking at direct visualization of the tracheal tube tip met our inclusion criteria. There were 81 intubations evaluated using neck ultrasound, 214 intubations evaluated using diaphragmatic or pleural sliding, and 165 intubations evaluated for feasibility of bedside ultrasound in visualizing tracheal tube tip placement. The sensitivities of transtracheal ultrasound for intubation were overall high ranging from 0.92 to 1.00 with excellent specificities at 1.00. For lung ultrasound, the sensitivities for tracheal placement versus esophageal placement were high at 1.00, but only one study reported esophageal intubations and had a specificity of 1.00. When assessing the appropriate tracheal tube depth for tracheal intubations using lung ultrasound, the sensitivities ranged from 0.91 to 1.00 with specificities ranging from 0.5 to 1.0. Regarding feasibility of direct visualization of tracheal tube tip, visualization ranged from 83% to 100%. CONCLUSION Bedside ultrasound has been described to be feasible in determining tracheal tube placement in several small single center studies and could be a useful adjunct tool in confirming tracheal tube placement in critically ill pediatric patients, but further studies are needed to assess its accuracy in a randomized multicenter setting.
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The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates. J Perinatol 2015; 35:481-4. [PMID: 25611791 DOI: 10.1038/jp.2014.240] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Revised: 11/26/2014] [Accepted: 12/05/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Given the distressingly high incidence of ETT malposition in the neonatal population, patients are exposed to ionizing radiation to confirm endotracheal tube (ETT) position. Our objective is to determine if ultrasound technique is concordant with X-ray in determining whether an ETT is deeply positioned or not. STUDY DESIGN Prospective observational clinical trial. After obtaining informed consent, patients with an ETT who required X-ray for clinical reasons underwent sonographic evaluation of the ETT by an ultrasound technologist or pediatric radiologist, usually within the hour. RESULTS A total of 56 image pairs were obtained from 29 patients. Ninety-eight percent of the ultrasound/X-ray image pairs were suitable for analysis. The concordance of ultrasound with X-ray to identify deeply and not deeply positioned ETTs was 95% (53/56). The sensitivity of ultrasound to detect deeply positioned ETTs on X-ray was 86% (6/7). The specificity of ultrasound to detect ETTs that were not deeply positioned on X-ray was 96% (47/49). CONCLUSIONS As the largest clinical trial of its kind to date, with the greatest number of ultrasound operators, we have further established US as a feasible imaging modality to determine whether an ETT is deeply positioned or not.
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Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation 2015; 89:8-12. [DOI: 10.1016/j.resuscitation.2014.08.033] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 08/08/2014] [Accepted: 08/24/2014] [Indexed: 10/24/2022]
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