Role of ultrasonography in the assessment of correct endotracheal tube placement in neonates

Descamps, Claire-Sophie; Beissel, Anne; Van, Philippe Vo; Butin, Marine; Stacoffe, Nicolas; Giai, Joris; Claris, Olivier; Nguyen, Khai T.

doi:10.1111/apa.15097

Cited by 12 publications

(25 citation statements)

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“…Following the above specified criteria we selected 14 studies, including a total of 602 ETT evaluation with a range from 9 to 143 procedures per work. The studies were published from 2012 to 2021 and conducted worldwide: 4 in the USA ( 23 , 26 , 35 , 36 ), 5 in Europe [Spain ( 11 , 25 ), Italy ( 37 ), France ( 24 ), Russia ( 38 )], 4 in Asia [India ( 39 , 40 ), Japan ( 41 ), Iran ( 27 )], 1 in South Africa ( 42 ). Table 1 provides the details of the studies included in the analysis, while Table 2 shows the methods' summary.…”

Section: Resultsmentioning

confidence: 99%

“…Regarding exclusion criteria, when specified, patients presenting facial dysmorphism ( 26 , 39 ) or upper airway or thoracic anomalies ( 23 , 24 , 26 , 37 , 39 ) were excluded for obvious reasons, as were patients with cardiac congenital defect ( 26 , 35 , 37 , 39 ) since different position of aortic arch or right pulmonary artery would have interfered with ETT position estimation. Lack of parental consent was also considered ( 36 ).…”

Section: Resultsmentioning

confidence: 99%

“…These POCUS scans were obtained from the suprasternal window with the probe placed in the midsagittal position. The distance between ETT tip and RPA was adopted by 4 studies ( 23 , 26 , 27 , 37 ), while 7 studies measured AoA—ETT distance ( 24 , 35 , 36 , 38 – 40 , 42 ). Another study estimated the correct position assessing bilateral lung sliding and checking for the absence of acoustic shadow artifact in a longitudinal scan (corresponding to the air in the trachea if ETT was too high).…”

Section: Resultsmentioning

confidence: 99%

“…Data available in literature provided some different methods for visualizing the ETT tip and determining its position in the newborn population. Dennington et al suggested placing the probe on the suprasternal notch to provide a midsagittal plane and, in order to confirm the tip is being seen, the ETT could be moved in and out ( 23 ), while in other studies a direct visualization of the ETT in the trachea is preferred ( 24 ). Other authors searched for the “comet tail” artifact ( 25 ) or the “double line” as confirmation of the tube in the trachea, while the superior right portion of right pulmonary artery or the aortic arch are the anatomic markers used for suggest the corrected ETT position ( 26 , 27 ).…”

Section: Introductionmentioning

confidence: 99%

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Sonographic Evaluation of the Endotracheal Tube Position in the Neonatal Population: A Comprehensive Review and Meta-Analysis

et al. 2022

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BackgroundEndotracheal 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 ObjectiveTo evaluate ultrasound efficacy in determining ETT placement adequacy in preterm and term newborns.Secondary ObjectiveTo compare the time required for ultrasound confirmation vs. time needed for other standard of care methods.Search MethodsA 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 CriteriaWe 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 ResultsWe 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.ConclusionPOCUS 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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sonographic Evaluation of the Endotracheal Tube Position in the Neonatal Population: A Comprehensive Review and Meta-Analysis

et al. 2022

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“…14 In children, the sensitivity and specificity for POCUS ETT placement has been shown to be 98.9% and 94.1%, respectively. 15 In neonates, POCUS has mainly been used in stable intubated NICU patients to determine ETT depth, [16][17][18][19][20] and only few studies have compare tracheal POCUS with standard methods of intubation confirmation. 21,22 Our group previously described a novel ultrasound simulator to train health care providers in distinguishing tracheal versus esophageal ETT placement.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy of Point-of-Care Ultrasound Compared to Standard-of-Care Methods for Endotracheal Tube Placement in Neonates

Ariff

Ali

Tessaro

et al. 2022

Preprint

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Introduction: Point of care ultrasound (POCUS) is a useful tool to determine endotracheal tube placement; however, few studies have compared it with standard methods of confirmation. 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 ETT placement was determined using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by a clinical team, and simultaneously by POCUS. 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. Using an expert as the reference standard, POCUS user interpretation showed 100% sensitivity and 94% specificity. We found a 99.4% agreement (Kappa: 0.96; p<0.001) between the POCUS user and expert. 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 (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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Diagnostic accuracy of point‐of‐care ultrasound compared to standard‐of‐care methods for endotracheal tube placement in neonates

Ariff

Ali

Tessaro

et al. 2022

Pediatric Pulmonology

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Role of ultrasonography in the assessment of correct endotracheal tube placement in neonates

Cited by 12 publications

References 5 publications

Sonographic Evaluation of the Endotracheal Tube Position in the Neonatal Population: A Comprehensive Review and Meta-Analysis

Sonographic Evaluation of the Endotracheal Tube Position in the Neonatal Population: A Comprehensive Review and Meta-Analysis

Diagnostic Accuracy of Point-of-Care Ultrasound Compared to Standard-of-Care Methods for Endotracheal Tube Placement in Neonates

Diagnostic accuracy of point‐of‐care ultrasound compared to standard‐of‐care methods for endotracheal tube placement in neonates

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