Ultrasonography for endotracheal tube position in infants and children

Abstract

US for ETT verification appears to be well tolerated in infants and children and may augment determination of proper ETT position in combination with other ETT verification modalities. Further studies are needed regarding technique and training. What is Known: • Point-of-care ultrasonography is realizing increased availability and use in several pediatric specialties. • Ultrasonography has been shown to be effective for verifying ETT position in adults but have been less studied in infants and children. What is New: • Ultrasonography for endotracheal tube verification appears to be well tolerated in infants and children. • Ultrasonography may augment determination of proper endotracheal tube position in combination with other verification modalities such as radiography and capnography in the pediatric population.

Oral endotracheal intubation in pediatric anesthesia

“…This view provides adequate visualization of the ETT tip 80% of the time, and is consistent with X-ray visualization in 73%-100% of cases [4,22]. The visualization of the ETT tip can be improved by the oscillation within a few millimeters in each direction, or by using an US "standoff pad" over the infant's chest and neck.…”

“…The transverse substernal view can be used to assess bilateral diaphragm motion, and the sagittal mid-axillary intercostal view can be used to observe lung sliding. This provides comparable performance to X-rays in terms of determining ETT position [4]. is helpful for ultrasonographic visualization of an ETT cuff at the suprasternal notch, can improve the detection of cuffs and rapidly confirm correct ETT insertion depth with a sensitivity of 98.8% and a specificity of 96.4% [20].…”

“…Transtracheal US is an effective tool for quickly and accurately identifying ETT placement with high sensitivity (0.92 to 1.00) and excellent specificity (1.00) [4,22].…”

Postępowanie w niespodziewanych trudnych drogach oddechowych u dzieci — stanowisko Sekcji Anestezjologii i Intensywnej Terapii Dziecięcej, Sekcji Przyrządowego Udrażniania Dróg Oddechowych Polskiego Towarzystwa Anestezjologii i Intensywnej Terapii oraz Po

“…In the operating theatre, E T CO 2 (capnography) is used while a CO 2 detector device may be used as an alternative in out-of-theatre settings [50][51][52]. The correct placement of the TT may be confirmed with ultrasound and a fibre-optic scope [53][54][55][56]. Re: (b).…”

“…The correct depth of TT insertion may sometimes require radiological confirmation (CXR) [31]. The tracheal tube placement can also be confirmed with an ultrasound [53][54][55][56]59]. A fibre--optic scope may be used for TT placement confirmation in some clinical situations.…”