Verification of endotracheal tube placement using ultrasound during emergent intubation of a preterm infant

Oulego-Erróz, Ignacio; Alonso-Quintela, Paula; Rodríguez-Blanco, Silvia; Zubillaga, D. Mata; Miaja, María Fernández

doi:10.1016/j.resuscitation.2012.02.014

Cited by 13 publications

(7 citation statements)

References 5 publications

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“…Low pulmonary flow will not disturb sonography images. Compared to direct visualisation during laryngoscopy, ultrasound allows verification of endotracheal tube location without disturbing ongoing cardiopulmonary resuscitation and with a decreased risk of unintended extubation [44]. …”

Section: Resultsmentioning

confidence: 99%

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

Adi¹,

Chuan

Manikam

2013

Crit Ultrasound J

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BackgroundIn emergency settings, verification of endotracheal tube (ETT) location is important for critically ill patients. Ignorance of oesophageal intubation can be disastrous. Many methods are used for verification of the endotracheal tube location; none are ideal. Quantitative waveform capnography is considered the standard of care for this purpose but is not always available and is expensive. Therefore, this feasibility study is conducted to compare a cheaper alternative, bedside upper airway ultrasonography to waveform capnography, for verification of endotracheal tube location after intubation.MethodsThis was a prospective, single-centre, observational study, conducted at the HRPB, Ipoh. It included patients who were intubated in the emergency department from 28 March 2012 to 17 August 2012. A waiver of consent had been obtained from the Medical Research Ethics Committee. Bedside upper airway ultrasonography was performed after intubation and compared to waveform capnography. Specificity, sensitivity, positive and negative predictive value and likelihood ratio are calculated.ResultsA sample of 107 patients were analysed, and 6 (5.6%) had oesophageal intubations. The overall accuracy of bedside upper airway ultrasonography was 98.1% (95% confidence interval (CI) 93.0% to 100.0%). The kappa value (Κ) was 0.85, indicating a very good agreement between the bedside upper airway ultrasonography and waveform capnography. Thus, bedside upper airway ultrasonography is in concordance with waveform capnography. The sensitivity, specificity, positive predictive value and negative predictive value of bedside upper airway ultrasonography were 98.0% (95% CI 93.0% to 99.8%), 100% (95% CI 54.1% to 100.0%), 100% (95% CI 96.3% to 100.0%) and 75.0% (95% CI 34.9% to 96.8%). The likelihood ratio of a positive test is infinite and the likelihood ratio of a negative test is 0.0198 (95% CI 0.005 to 0.0781). The mean confirmation time by ultrasound is 16.4 s. No adverse effects were recorded.ConclusionsOur study shows that ultrasonography can replace waveform capnography in confirming ETT placement in centres without capnography. This can reduce incidence of unrecognised oesophageal intubation and prevent morbidity and mortality.Trial registrationNational Medical Research Register NMRR11100810230.

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Section: Resultsmentioning

confidence: 99%

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

Adi¹,

Chuan

Manikam

2013

Crit Ultrasound J

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“…In pediatric and neonatal populations, studies have shown that POC-US is a feasible tool that has been used clinically to verify both correct endotracheal tube (ETT) placement and an acceptable ETT tip position 71,72,73,74,75 . Proper ETT placement includes both tracheal intubation and an acceptable ETT tip position.…”

Section: Examining Correct Ett Placement and Positionmentioning

confidence: 99%

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Liu¹,

Copetti

Sorantin

et al. 2019

JoVE

102

162

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Ultrasound is a safe bedside imaging tool that obviates the use of ionizing radiation diagnostic procedures. Due to its convenience, the lung ultrasound has received increasing attention from neonatal physicians. Nevertheless, clear reference standards and guideline limits are needed for accurate application of this diagnostic modality. This document aims to summarize expert opinions and to provide precise guidance to help facilitate the use of the lung ultrasound in the diagnosis of neonatal lung diseases.

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“…We believe that the use of neck US to confirm neonatal endotracheal intubation in newborn infants with unstable cardiorespiratory conditions is extremely useful. Several published reports state that the confirmation of endotracheal intubation via neck US is effective in neonatal intensive care units; however, to the best of our knowledge, there are no other reports on the use of this technique in newborn infants. The reason for this lack of information may be due to problems in arranging US equipment.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic confirmation of endotracheal intubation in extremely low birthweigh infants – secondary publication

Takeuchi

Arai

Nagafuji

et al. 2020

Pediatrics International

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Background The purpose of this study was to investigate the usefulness of ultrasonography (US) for confirmation of endotracheal tube (ETT) placement during resuscitation in extremely low birthweight (ELBW) infants. Methods We conducted a retrospective review of the medical records of ELBW infants in whom ETT position was verified using US between June 2016 and September 2017. We investigated the backgrounds of the patients and US investigators, and the time required for the detection of exhaled carbon dioxide using the colorimetric method and US. Results Eleven ELBW infants were evaluated using US by four neonatologists. The median duration required to determine the ETT position by the colorimetric method and US were 11 s and 3 s, respectively. In six ELBW infants, we were able to verify the ETT position more rapidly using US than using the colorimetric method, and were able to perform prompt resuscitation. Unnecessary reintubations were avoided in three ELBW infants. Conclusion Ultrasonography allowed the swift confirmation of the tracheal intubations. The colorimetric method yielded false negative results; in such cases, unnecessary reintubation could have been avoided if US was used. We assessed the mechanism of false negative results and performed appropriate resuscitation.

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Verification of endotracheal tube placement using ultrasound during emergent intubation of a preterm infant

Cited by 13 publications

References 5 publications

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation

Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus

Ultrasonographic confirmation of endotracheal intubation in extremely low birthweigh infants – secondary publication

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