Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Sheth, Mansi; Jaeel, Pooja; Nguyen, Jimmy

doi:10.1055/s-0036-1597846

Cited by 15 publications

(26 citation statements)

References 18 publications

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“…In a randomised trial, Blayney et al 30 reported that a magnetically detectable ETT was superior to vocal cord guide in detecting ETT position. Ultrasound confirmation of ETT tip position was described by Slovis and Poland,31 and several studies show promising results 32 33. These and other methods of estimating ETT insertion depth, such as NTL, foot length34 and oro-helical length,35 require further evaluation.…”

Section: Discussionmentioning

confidence: 98%

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight

Murphy¹,

Donoghue

O’Donnell

2019

Arch Dis Child Fetal Neonatal Ed

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BackgroundEndotracheal tube (ETT) tip position is determined on chest X-ray (CXR) and should lie between the upper border of the first thoracic vertebra (T1) and the lower border of second thoracic vertebra (T2). Infant weight is commonly used to estimate how far the ETT should be inserted but frequently results in malpositioned ETT tips. Palpation of the ETT tip at the suprasternal notch has been recommended as an alternative.ObjectiveTo determine whether estimating ETT insertion depth using suprasternal palpation of the ETT tip rather than weight results in more correctly positioned ETT tips.DesignSingle-centre randomised controlled trial.SettingLevel III neonatal intensive care unit (NICU) at a university maternity hospital.PatientsNewborn infants without congenital anomalies intubated in the NICU.InterventionsParticipants were randomised to have ETT insertion depth estimated using palpation of the ETT tip at the suprasternal notch or weight [insertion depth (cm)=6 + wt (kg)].Main outcome measureCorrect ETT position, that is, between the upper border of T1 and lower border of T2 on CXR, determined by one consultant paediatric radiologist masked to group assignment.ResultsThere was no difference in the proportion of correctly placed ETT tips between the groups (suprasternal palpation 27/58 (47%) vs weight 23/60 (38%), p=0.456). Most incorrectly positioned ETTs were too low (56/68 (82%)).ConclusionEstimating ETT insertion depth using suprasternal palpation did not result in more correctly positioned ETTs.Trial registration numberISRCTN13570106.

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Section: Discussionmentioning

confidence: 98%

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight

Murphy¹,

Donoghue

O’Donnell

2019

Arch Dis Child Fetal Neonatal Ed

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show abstract

“…Despite various proposed methods and technologies to guide endotracheal tube (ETT) depth in infants and children, [1][2][3][4][5] ETTs are frequently incorrectly positioned in this patient population, although there is a large variance in the proportion reported in the literature. 4,6 Chest radiography remains the standard of care for confirming appropriate ETT position within the trachea, which requires equipment and personnel to be brought to the bedside.…”

Section: Optoacoustic Evaluation Of Endotracheal Tube Depth In Pediatmentioning

confidence: 99%

Optoacoustic Evaluation of Endotracheal Tube Depth in Pediatrics

et al. 2018

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“…A common standard of care practice for confirming ETT position is radiography. NICU patients undergo an average of over 10 radiographs per admission adding radiation exposure that has been linked to an increased long‐term risk of cancer and cognitive decline . Ultrasonography for ETT verification appears to be well tolerated in both the neonate and the pediatric population, and seems a helpful adjunct in determining proper ETT position in combination with other ETT verification modalities .…”

Section: Introductionmentioning

confidence: 99%

“…NICU patients undergo an average of over 10 radiographs per admission adding radiation exposure that has been linked to an increased long‐term risk of cancer and cognitive decline . Ultrasonography for ETT verification appears to be well tolerated in both the neonate and the pediatric population, and seems a helpful adjunct in determining proper ETT position in combination with other ETT verification modalities . This helps clinician comply with the Choosing Wisely campaign advocating against routine daily XR done solely to check ETT position in intubated infants .…”

Section: Introductionmentioning

confidence: 99%

Airway ultrasound: Point of care in children—The time is now

Daniel

Bertolizio

McHugh

2020

Pediatric Anesthesia

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Background Point‐of‐care ultrasonography of the airway is becoming a first‐line noninvasive adjunct assessment tool of the pediatric airway. It is defined as a focused and goal‐directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider. Successful use requires a thorough understanding of airway anatomy and ultrasound experience. Aims To outline the many benefits, and some limitations, of airway ultrasonography in the clinical and perioperative setting. Materials and Methods Expert review of the recent literature. Results Ultrasound assessment of the airway may provide the clinician with valuable information that is specific to the individual airway static and dynamic anatomy of the patient. Ultrasound can help identify vocal cord dysfunction and pathology, assess airway size, predict the appropriate diameter of endotracheal and tracheostomy tubes, differentiate tracheal from esophageal intubation, localize the cricothyroid membrane for emergency airway access and identify tracheal rings for US‐guided tracheostomy. Ultrasonography is also a great tool for the intraoperative diagnosis of a pneumothorax, the visualization of the movement of the diaphragms, and quantifying the amount of gastric content. Ultrasonography signs, tips, and pearls that allow these diagnoses are highlighted. The major disadvantage of ultrasonography remains interobserver variability, and operator dependence, as it requires specific training and experience. Conclusion Although it is not standard of care yet, there is significant potential for the integration of ultrasound technology into the routine care of the airway.

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Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Cited by 15 publications

References 18 publications

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight

Randomised trial of estimating oral endotracheal tube insertion depth in newborns using suprasternal palpation of the tip or weight

Optoacoustic Evaluation of Endotracheal Tube Depth in Pediatrics

Airway ultrasound: Point of care in children—The time is now

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