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Published on: April 7, 2023
Detection and correction of endotracheal-tube position in premature neonates
Malte Lange1, Susanne Jonat, Werner Nikischin
1Department of Pediatrics, Children's Hospital, University of Kiel, Kiel, Germany. mlange@pediatrics.uni-kiel.de
Insights
Accurate endotracheal tube (ETT) placement in premature infants is vital. A new mathematical correction for chest radiographs accounts for head movement, improving ETT position accuracy to under 2mm in 97.3% of cases.
Area of Science:
- Neonatal Medicine
- Pediatric Critical Care
- Medical Imaging
Background:
- Accurate endotracheal tube (ETT) placement is critical for mechanical ventilation in premature infants due to their short airways.
- Chest radiographs are used to verify ETT position, but head movement can significantly alter perceived placement, leading to potential extubation or main-stem intubation.
- Existing methods lack a reliable way to correct for variations in head position during radiography.
Purpose of the Study:
- To develop and validate a mathematical algorithm to correct endotracheal tube (ETT) position on chest radiographs based on head position.
- To improve the accuracy of ETT placement verification in preterm neonates, regardless of head positioning during imaging.
- To provide a tool for estimating ETT depth when radiography is not immediately available.
Main Methods:
- Analysis of 111 chest radiographs from 24 preterm neonates (gestational age 24-29 weeks, weight 500-1,000 g).
- Development of a mathematical algorithm using ratios of anatomical landmarks to estimate head position and correct ETT depth.
- Validation of the algorithm's accuracy in determining ETT distance from the midtracheal level.
Main Results:
- The developed mathematical algorithm demonstrated high accuracy in correcting ETT positions.
- In 97.3% of cases (108 out of 111 radiographs), the corrected ETT-position was within 2 mm of the midtracheal level.
- The algorithm effectively compensates for variations in head and neck positioning during radiography.
Conclusions:
- The proposed correction equation for head position enables accurate verification of endotracheal tube (ETT) placement without requiring specific head positioning during radiography.
- This method significantly enhances the reliability of ETT position assessment in preterm neonates.
- The algorithm offers potential utility in estimating ETT insertion depth in situations where radiographic confirmation is not feasible.
Abstract:
Due to the short airways in premature children, an accurate position of the endotracheal tube (ETT) is crucial for adequate mechanical ventilation. Verification of ETT-position is done in chest radiographs. However, ETT-position varies substantially with head movement. When the head is flexed, the tube might appear too deeply inserted, and inadvertent extubation may occur in cases of retraction of ETT after radiography. Extension of the cervical spine will suggest an inappropriately high ETT-position, so that intended corrections can lead to main-stem intubation. Radiographic visible skeletal structures could serve as reference points to allow the detection of head declination and imperfect positioning of ETT. Ratios of anatomical landmarks were used to estimate head position. In this study, 111 radiographs of 24 preterm neonates with a gestational age of 24-29 weeks and weights of 500-1,000 g were analyzed. A mathematical algorithm for the detection and correction of ETT-positions, based on common chest radiographs, was developed. In 108 cases (97.3%), ETT-distance from the midtracheal level was less than 2 mm after use of the proposed correction.Thus, the suggested correction equation for head position enables verification of the actual ETT-position without requiring a defined placement of the head during radiography. Moreover, it can be helpful for estimating the depth of ETT-insertion in conditions when radiography is not available.
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