Applications of Airway Ultrasound for Endotracheal Intubation in Pediatric Patients: A Systematic Review

Abstract

Endotracheal intubation is a challenging procedure for pediatric patients. Airway ultrasound as a new technology is suitable for aiding this process, but its diagnostic value remains unclear. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and the Chinese biomedical literature database to summarize specific applications of airway ultrasound in each step of endotracheal intubation in pediatric patients. Diagnostic accuracy and 95% confidence interval were used as outcomes. In total, 33 studies (6 randomized controlled trials and 27 diagnostic studies) with 1934 airway ultrasound examinations were included. Population included neonates, infants, and older children. Airway ultrasound could be used to determine the endotracheal tube size and confirm endotracheal intubation and intubation depth; the diagnostic accuracy for all these factors was 23.3–100%, 90.6–100%, and 66.7–100%, respectively. Furthermore, the accuracy of airway ultrasound in predicting endotracheal tube size was consistently higher than traditional methods, such as height formula, age formula, and the width of the little finger. In conclusion, airway ultrasound has unique advantages for confirming successful endotracheal intubation in pediatric patients, and it may become an effective auxiliary tool in this field. There is a need to develop a unified airway ultrasound protocol to conduct clinical trials and practice in the future.

The Effect of the Ultrasonography Measurement Method and the Conventional Measurement Method Used in Endotracheal Tube Size Selection in the Pediatric Patient Group on Postextubation Complications and Patient Recovery

“…Failure to determine the appropriate intubation tube may lead to long-term adverse outcomes such as subglottic stenosis and granuloma formation, as well as cause postoperative cough, stridor, laryngospasm, tachypnea, and wheezing [ 18 ]. Many studies have shown that USG can detect the upper airway diameter more than 80% more effectively than traditional methods, especially in the adult population [ 23 , 24 ]. However, no consensus meta-analysis gives an exact ratio in pediatric patients.…”

Cervical ultrasound for endotracheal intubation confirmation in dogs by veterinary students: a cadaveric study

“…Cervical ultrasound for endotracheal intubation confirmation in dogs by veterinary students: a cadaveric study A systematic review found no statistically significant differences in accuracy between US and capnography in confirming ET intubation in neonates (Liu et al, 2023). Yet, considering the brief single training session and inexperienced students performing the exams, results here presented are insufficient to indicate US as a substitute for capnography in ET intubation confirmation.…”

“…Albeit usually a simple and fast maneuver in dogs, ET intubation can be quite challenging in some situations such as cardiopulmonary resuscitation (CPR) or trauma, especially for inexperienced veterinarians. Unrecognized ET tube misplacement in the esophagus is a life-threatening complication and a significant source of malpractice claims in medicine ( Chenkin et al, 2015 ; Honardar et al, 2017 ; Liu et al, 2023 ). Therefore, confirming correct tube placement is a key step whenever this procedure is performed ( Abbasi et al, 2015 ; Grubb et al, 2020 ).…”

“…Although described decades ago ( Raphael & Conard III, 1987 ), just recently ultrasound (US) has emerged as an alternative to confirm ET intubation in veterinary medicine ( Herreria-Bustillo et al, 2016 ). Studies in humans have shown promising results, demonstrating high accuracy for the method and a fast learning curve ( Chenkin et al, 2015 ; Chou et al, 2011 ; Liu et al, 2023 ). Nonetheless, most research has focused on experienced practitioners and up to now only one study was performed in veterinary medicine ( Herreria-Bustillo et al, 2016 ).…”

Development of an augmented reality system for tracheal intubation guidance of airway management

“…Currently, 3D printed models based on CT scans and ultrasound-guided intubation are being used or tested for device fitting and procedure guidance to increase the success rate of intubation [2][3][4][5][6], but both have limitations. Maintaining a 3D printing facility can be logistically inconvenient, and ultrasound-guided intubation can be hindered by operator dependence, limited two-dimensional visualization, and potential artifacts.…”