Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation

Quintela, Paula Alonso; Erroz, Ignacio Oulego; Matilla, M. Mora; Blanco, S. Rodríguez; Zubillaga, D. Mata; Santos, Laura Regueras

doi:10.1016/j.anpede.2014.01.002

Cited by 21 publications

(29 citation statements)

References 22 publications

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“…Given these facts, reviews of the current literature propose that a combination of direct visualization of the ETT in the trachea with measurement of pleural movements using ultrasonography is effective for confirming proper ETT placement . Only 1 study demonstrated a high sensitivity and specificity of 100% and 75%, respectively; however, the sample size of this study was small, at only 15 pediatric patients, and hemodynamically unstable patients such as those with cardiopulmonary arrest were excluded. Our study also combined neck and lung ultrasonography as described above and was able to demonstrate a higher specificity of 100% regardless of the severity of the patients’ condition.…”

Section: Discussionmentioning

confidence: 83%

“…However, neither the sample size nor the study design of these studies was satisfactory for demonstrating the accuracy of the procedure . In contrast, the use of pleural or diaphragm movements had 91% to 100% sensitivity and 50% to 75% specificity for identifying proper ETT depth . Although other lung pathologies, such as pneumothorax, affect the movement of the pleura, lung sliding can be useful for evaluating ETT depth as long as we are aware of its limitations.…”

Section: Discussionmentioning

confidence: 95%

“…Rapidity is one of the most important factors for emergency intubation because in pediatric patients, the functional residual capacity is smaller than in adults, and inappropriate intubation can easily lead to hypoxia . Prospective studies showed that neck and lung ultrasonography can be performed more quickly than either capnography or chest x ray . The rapidity of the procedure can greatly aid the work of emergency physicians performing an emergency intubation.…”

Section: Discussionmentioning

confidence: 99%

“…For example, ultrasonography of the anterior neck directly visualizing the hyperechoic structure of the ETT in the trachea demonstrated a high specificity for tracheal intubation compared with capnography . Lung sliding visualized by ultrasonography (showing the movement of the pleura in both lungs) showed high sensitivity and specificity in differentiating tracheal from endobronchial mainstem intubation . However, strong evidence supporting the examination is still lacking due to inadequate study design or small sample sizes.…”

mentioning

confidence: 99%

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Diagnostic Accuracy of a 3‐Point Ultrasound Protocol to Detect Esophageal or Endobronchial Mainstem Intubation in a Pediatric Emergency Department

Mori

Nomura

Hagiwara

et al. 2019

J of Ultrasound Medicine

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Objectives The aim of this study was to evaluate the diagnostic accuracy of the 3‐point approach with ultrasonography for confirming endotracheal tube (ETT) placement in pediatric patients. Methods This was a prospective study conducted at a tertiary care center in Japan between March 2014 and March 2016. Children aged 0 to 18 years requiring endotracheal intubation in our emergency department (ED) who underwent ultrasonography for confirming ETT placement were enrolled. Patients who had already undergone a tracheotomy or intubation before arrival at our ED or who had severe neck injuries hindering ultrasonography were excluded. Quantitative capnography and portable chest x‐ray imaging were used as the reference standard for the confirmation of proper ETT placement. The main outcome was the diagnostic accuracy of the 3‐point approach with ultrasonography for detecting inappropriate ETT placement. Results In total, 68 patients were enrolled. The median age was 17 months (interquartile range, 8–40), and 51.4% were males. Three (4.4%) and 7 (10.3%) patients had esophageal and endobronchial mainstem intubation, respectively. The patients received emergency intubation due to a dysfunction of the central nervous system (45.6%) or respiratory failure (22.0%). The sensitivity and specificity of esophageal versus tracheal intubation was 100% (95% confidence interval [CI], 54.9%–100.0%) and 100% (95% CI, 97.9%–100.0%), respectively, whereas for endobronchial mainstem intubation versus tracheal intubation, the sensitivity and specificity was 85.7% (95% CI, 56.7%–96.0%) and 98.3% (95% CI, 94.8%–99.5%), respectively. Agreement between the reviewers was high (kappa coefficient, 0.78). Conclusion The 3‐point approach with ultrasonography was a feasible method for detecting esophageal and endobronchial mainstem intubation in pediatric patients.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Diagnostic Accuracy of a 3‐Point Ultrasound Protocol to Detect Esophageal or Endobronchial Mainstem Intubation in a Pediatric Emergency Department

Mori

Nomura

Hagiwara

et al. 2019

J of Ultrasound Medicine

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“…However, when these are not available or in certain clinical scenarios, for instance in a patient with prolonged cardiac arrest or large pulmonary embolism when capnography is not reliable, bedside ultrasound can rapidly and accurately differentiate between esophageal vs. endotracheal intubation. A single view of trachea and esophagus at the level of cricothyroid membrane, while performing laryngoscopy and intubation predicts tracheal intubation with a sensitivity of 92–100% and a specificity of 100% ( 89 , 90 ). The clinician can further measure the width of the air column at the level of cricoid cartilage to predict the correct size of cuffed (98% accuracy) and uncuffed (95% accuracy) endotracheal tubes ( 91 ).…”

Section: Current State Of Critical Care Point-of-care Ultrasoundmentioning

confidence: 99%

Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

2022

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Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.

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