Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 26 , ISSUE 11 ( November, 2022 ) > List of Articles

Pediatric Critical Care

Assessment of the Endotracheal Tube Tip Position by Bedside Ultrasound in a Pediatric Intensive Care Unit: A Cross-sectional Study

Seenivasan Subramani, Narayanan Parameswaran, Ramesh Ananthkrishnan, Shilpa Abraham, Muthu Chidambaram, Ramachandran Rameshkumar, Mahadevan Subramanian

Keywords : Bedside ultrasound, Children, Endotracheal tube tip position

Citation Information : Subramani S, Parameswaran N, Ananthkrishnan R, Abraham S, Chidambaram M, Rameshkumar R, Subramanian M. Assessment of the Endotracheal Tube Tip Position by Bedside Ultrasound in a Pediatric Intensive Care Unit: A Cross-sectional Study. Indian J Crit Care Med 2022; 26 (11):1218-1224.

DOI: 10.5005/jp-journals-10071-24355

License: CC BY-NC 4.0

Published Online: 31-10-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Introduction: The chest X-ray (CXR) is the standard of practice to assess the tip of the endotracheal tube (ETT) in ventilated children. In many hospitals, it takes hours to get a bedside CXR, and it has radiation exposure. The objective of this study was to find the utility of bedside ultrasound (USG), in assessing the ETT tip position in a Pediatric Intensive Care Unit (PICU). Methods: It was a prospective study conducted in the PICU of a tertiary care center involving 135 children aged from 1 month to 60 months, requiring endotracheal intubation. In this study, the authors compared the position of the ETT tip by the CXR (gold standard) and USG. The CXR was taken in children to assess the correct position of the tip of ETT. The USG was used to measure the distance between the tip of ETT and the arch of the aorta, thrice in the same patient. The mean of the three USG readings was compared with the distance between the tip of the ETT and carina in CXR. Results: The reliability of three USG readings was tested by absolute agreement coefficient in intraclass correlation (ICC), 0.986 (95% CI: 0.981–0.989). The sensitivity and specificity of the USG in identifying the correct position of the ETT tip in children when compared to CXR were 98.10% (95% CI: 93.297–99.71%) and 50.0% (95% CI: 31.30–68.70%), respectively. Conclusion: In ventilated children <60 months of age, identifying the tip of ETTs by bedside the USG has good sensitivity (98.10%) but poor specificity (50.0%).


PDF Share
  1. Neunhoeffer F, Wahl T, Hofbeck M, Renk H, Esslinger M, Hanelt M, et al. A new method for determining the insertion depth of tracheal tubes in children: a pilot study. Br J Anaesth 2016;116:393–397. DOI: 10.1093/bja/aev545.
  2. Peterson J, Johnson N, Deakins K, Wilson-Costello D, Jelovsek JE, Chatburn R. Accuracy of the 7-8-9 Rule for endotracheal tube placement in the neonate. J Perinatol Off J Calif Perinat Assoc 2006;26:333–336. DOI: 10.1038/sj.jp.7211503.
  3. Kemper M, Dullenkopf A, Schmidt AR, Gerber A, Weiss M. Nasotracheal intubation depth in paediatric patients. Br J Anaesth 2014;113:840–846. DOI: 10.1093/bja/aeu229.
  4. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Paediatr Anaesth 2006;16:1238–1243. DOI: 10.1111/j.1460-9592.2006.01982.x.
  5. Tochen ML. Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. J Pediatr 1979;95:1050–1051. DOI: 10.1016/s0022-3476(79)80309-1.
  6. Shukla HK, Hendricks-Munoz KD, Atakent Y, Rapaport S. Rapid estimation of insertional length of endotracheal intubation in newborn infants. J Pediatr 1997;131:561–564. DOI: 10.1016/s0022-3476(97)70062-3.
  7. Kuhns LR, Poznanski AK. Endotracheal tube position in the infant. J Pediatr 1971;78:991–996. DOI: 10.1016/s0022-3476(71)80429-8.
  8. Hossein-Nejad H, Payandemehr P, Bashiri SA, Nedai HH-N. Chest radiography after endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31:1181–1182. DOI: 10.1016/j.ajem. 2013.04.032.
  9. Brunel W, Coleman DL, Schwartz DE, Peper E, Cohen NH. Assessment of routine chest roentgenograms and the physical examination to confirm endotracheal tube position. Chest 1989;96:1043–1045. DOI: 10.1378/chest.96.5.1043
  10. Koshy T, Misra S, Chatterjee N, Dharan BS. Accuracy of a chest X-ray-based method for predicting the depth of insertion of endotracheal tubes in pediatric patients undergoing cardiac surgery. J Cardiothorac Vasc Anesth 2016;30:947–953. DOI: 10.1053/j.jvca.2016.01.031.
  11. Simons T, Söderlund T, Handolin L. Radiological evaluation of tube depth and complications of prehospital endotracheal intubation in pediatric trauma: A descriptive study. Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc 2017;43:797–804. DOI: 10.1007/s00068-016-0758-2.
  12. Levy FH, Bratton SL, Jardine DS. Routine chest radiographs following repositioning of endotracheal tubes are necessary to assess correct position in pediatric patients. Chest 1994;106:1508–1510. DOI: 10.1378/chest.106.5.1508.
  13. Chen S, Zhang M, Yao L, Xu W. Endotracheal tubes positioning detection in adult portable chest radiography for intensive care unit. Int J Comput Assist Radiol Surg 2016;11:2049–2057. DOI: 10.1007/s11548-016-1430-3.
  14. Slovis TL, Poland RL. Endotracheal tubes in neonates: sonographic positioning. Radiology 1986;160:262–263. DOI: 10.1148/radiology. 160.1.3520649.
  15. Sethi A, Nimbalkar A, Patel D, Kungwani A, Nimbalkar S. Point of care ultrasonography for position of tip of endotracheal tube in neonates. Indian Pediatr 2014;51:119–121. DOI: 10.1007/s13312-014-0353-8.
  16. Ali Z, Karim H, Wali N, Naraghi R. The inter- and intra-rater reliability of the Maestro and Barroco metatarsal length measurement techniques. J Foot Ankle Res 2018;11:47. DOI: 10.1186/s13047-018-0289-7.
  17. Zhou LY, Su C, Liu TJ, Li XM. Validity and reliability of the Ocular Motor Nerve Palsy Scale. Neural Regen Res 2018;13:1851–1856. DOI: 10.4103/1673-5374.238716.
  18. Feng D, Svetnik V, Coimbra A, Baumgartner R. A comparison of confidence interval methods for the concordance correlation coefficient and intraclass correlation coefficient with small number of raters. J Biopharm Stat 2014;24:272–293. DOI: 10.1080/10543406.2013.863780.
  19. Kao JS, Mao D, Wang RF, Chong CF, Chen KC. Confirmation of endotracheal tube placement with ultrasound – direct visualisation with anterior neck compression and continued surveillance. Anaesth Crit Care Pain Med 2019;38:393–394. DOI: 10.1016/j.accpm.2018.04.010.
  20. Li Y, Xie Y, Hu B, Wang J, Song H, Wei X. Sensitivity and specificity of a novel approach to confirm the depth of the endotracheal tube: A pilot study. Medicine 2015;94(34):e1460. DOI: 10.1097/MD.0000000000001460.
  21. Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation 2015;89:8–12. DOI: 10.1016/j.resuscitation.2014.08.033.
  22. Najib K, Pishva N, Amoozegar H, Pishdad P, Fallahzadeh E. Ultrasonographic confirmation of endotracheal tube position in neonates. Indian Pediatr 2016;53:886–888. DOI: 10.1007/s13312-016-0953-6.
  23. Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology 2012;102: 185–189. DOI: 10.1159/000338585.
  24. Singh P, Thakur A, Garg P, Aggarwal N, Kler N. Normative data of optimally placed endotracheal tube by point-of-care ultrasound in neonates. Indian Pediatr 2019;56:374–380. PMID: 31102379.
  25. Jaeel P, Sheth M, Nguyen J. Ultrasonography for endotracheal tube position in infants and children. Eur J Pediatr 2017;176:293–300. DOI: 10.1007/s00431-017-2848-5.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.