Diagnostic value of pleural ultrasound to refine endotracheal tube placement in pediatric intensive care unit

Guerder, Margaux; Maurin, Olga; Merckx, Audrey; Foissac, Frantz; Oualha, Mehdi; Renolleau, Sylvain; Vedrenne-Cloquet, Meryl

doi:10.1016/j.arcped.2021.09.006

Cited by 3 publications

(3 citation statements)

References 27 publications

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“…5 A possible alternative is the use of point-of-care ultrasound to confirm endotracheal tube placement, which has been trialed in the pediatric intensive care population in recent years with mixed findings. 23,24 This highlights an area for future research in deimplementation and knowledge translation.…”

Section: Discussionmentioning

confidence: 99%

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Wollny

Metcalfe

Benzies

et al. 2022

J Pediatr Intensive Care

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The purpose of this study was to describe the care of intubated patients in pediatric critical care. Acknowledging there are several perceived factors that contribute to unplanned extubations, a secondary objective was to describe how practice variation may relate to observed differences in unplanned extubation rates. A survey about practices related to the care of intubated patients was distributed to all pediatric intensive care units (PICUs) participating in the Virtual Pediatric Systems (VPS, LLC). Unplanned extubation rates for 2019 to 2020 were obtained from VPS. Univariate and bivariate analyses were performed to describe the responses, with unplanned extubation rates calculated as means. The text responses about perceived causes of unplanned extubation in participants' sites were explored using thematic content analysis. A total of 44 PICUs were included in this study (response rate 37.0%). The mean unplanned extubation rate for the sample was 0.41 (95% confidence interval: 0.31–0.50) per 100 intubation days. Variability was found across several aspects that impact care, including staffing, the frequency of procedures (e.g., chest radiography), and treatment-related goals (e.g., sedation and mobilization). The perceived causes of unplanned extubations in the sample included patient-, staff-, and equipment-related factors. We found practice variability in pediatric critical care units related to the care of intubated patients, which may contribute to the frequency of adverse events. As evidence emerges and professional associations and organizations recommend the best practices, knowledge translation will be required for the implementation and deimplementation of practices to improve the quality of care in PICUs.

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Section: Discussionmentioning

confidence: 99%

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Wollny

Metcalfe

Benzies

et al. 2022

J Pediatr Intensive Care

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“…Lung auscultation, although also helpful, has limitations, especially in settings with increased environmental noise, full use of personal protective equipment, and in patients with large body habitus (Dirzu, 2020;Itoh et al, 2020;Kuppusamy et al, 2022;Rajan et al, 2017). Chest X-ray is helpful in assessing tube location and depth, but patients are exposed to ionized radiation and need to be moved, and it is not feasible to repeat after moving the patient and may not be available in all settings (Guerder et al, 2021;Itoh et al, 2020;Tessaro et al, 2015). The use of ultrasonography to assess for placement has been shown to have a high level of sensitivity and specificity (98.2% and 95.7%, respectively) (Sahu et al, 2020).…”

Section: Implications For the Emergency Nurse Practitionermentioning

confidence: 99%

“…Esophageal detector devices (EDDs) have been found to have high sensitivity when compared to capnometry and auscultation (Bozeman, Hexter, Liang, Kelen, 1996). Lastly, chest X-ray is time-consuming, and there is increased exposure to ionized radiation, so it may not be available in every setting immediately (Guerder et al, 2021; Itoh et al, 2020; Tessaro, Salant, Arroyo, Haines, Dickman, 2015).…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Ultrasonography to Confirm Endotracheal Tube Placement

Gonzalez,

Ortega,

Gonzalez

et al. 2024

Advanced Emergency Nursing Journal

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Ensuring correct placement of the endotracheal tube (ETT) during intubation is an important step to avoid complications. Appropriate placement of the ETT can be challenging and, if done incorrectly, can lead to complications such as hypoxemia, atelectasis, hyperinflation, barotrauma, cardiovascular instability, end organ damage, and even death. Although several procedures exist to help assess ETT confirmation, all have limitations, are not always reliable, and vary in their degree of accuracy. Point-of-care ultrasound (POCUS) has emerged as a useful tool in the emergency department for quick diagnosis and treatment of many emergency conditions (Gonzalez et al., 2020). The purpose of this paper is to describe a systematic approach for the emergency nurse practitioner to use POCUS to assess proper endotracheal placement and the positioning within the trachea based on prior studies that compare this modality to traditional ones.

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5-point airway (5-AIR) ultrasound protocol for confirmation of endotracheal intubation and position in paediatric patients undergoing surgery: A prospective observational study

Baruah,

Ahmad,

Waindeskar

et al. 2024

Indian Journal of Anaesthesia

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Background and Aims: We devised and compared the accuracy and time required for a 5-point airway (5-AIR) ultrasound (USG) protocol for confirming endotracheal intubation (ETI) and endotracheal tube (ETT) positioning (ETP) with the current reference standard of quantitative waveform capnography (QWC) and auscultation. Methods: In this prospective observational study, 75 American Society of Anesthesiologists physical status I or II children between 2 and 12 years undergoing elective surgery were recruited. ETI and ETP were confirmed clinically and sonographically using the 5-AIR USG protocol, which involves real-time tracheal USG followed by bilateral pleural and diaphragmatic ultrasonography. Results: There was no oesophageal intubation in this study; hence, the accuracy of the USG protocol for ETI could not be determined. For ETP, 68 patients had correctly placed ETTs. The 5-AIR USG protocol identified 4 out of 7 endobronchial placements, resulting in a sensitivity of 100%, specificity of 57.14%, and an overall diagnostic accuracy of 96%. The mean time for confirmation of ETI by QWC (20.77 s (standard deviation (SD): 4.11 s; 95% confidence interval (CI): 19.84, 21.70) was longer than real-time tracheal USG (2.11 s (SD: 0.31 s; 95% CI: 2.04, 2.18) (P = 0.001). For ETP, the mean time for 5-point auscultation was 12.69 s (SD: 2.48 s; 95% CI: 12.19, 13.25) versus 6.39 s (SD: 0.54 s; 95% CI: 6.27, 6.51) for pleural USG (P = 0.001). Adding diaphragmatic scanning increased the mean time to 11.45 s (SD: 0.87 s; 95% CI: 11.25, 11.65) and 30.68 s (SD: 2.01 s; 95% CI: 30.22, 31.13) if a probe change was required (P = 0.001). Conclusion: The 5-AIR USG protocol was useful, fast, and demonstrated high diagnostic accuracy to confirm endotracheal intubation and position in paediatric patients. This protocol may be incorporated along with clinical signs, auscultation, and QWC to confirm endotracheal intubation and position.

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Diagnostic value of pleural ultrasound to refine endotracheal tube placement in pediatric intensive care unit

Cited by 3 publications

References 27 publications

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Practice Variability and Unplanned Extubation Rates across Pediatric Intensive Care Units

Point-of-Care Ultrasonography to Confirm Endotracheal Tube Placement

5-point airway (5-AIR) ultrasound protocol for confirmation of endotracheal intubation and position in paediatric patients undergoing surgery: A prospective observational study

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