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Relationship Between Evaluations of Tracheal Tube Position Using Ultrasound and Fluoroscopy in an Infant and
Davinder Ramsingh1, Elizabeth Ghazal1, Brent Gordon2
1Department of Anesthesiology, Loma Linda University Medical Center, 11234 Anderson Street, Loma Linda, CA MC-2532-D, USA.
Insights
Point-of-care ultrasound (POCUS) offers a safe, non-radiographic method for measuring tracheal tube (TT) placement in children. This study confirms POCUS accurately correlates with fluoroscopy for pediatric TT localization.
Area of Science:
- Pediatric Anesthesiology
- Medical Imaging
- Ultrasound Technology
Background:
- Assessing tracheal tube (TT) placement in children traditionally involves fluoroscopy, raising radiation exposure concerns.
- Point-of-care ultrasound (POCUS) is a valuable non-radiographic tool for pediatric airway management.
- Existing POCUS methods for pediatric TT localization can be age-dependent and require specialized techniques.
Purpose of the Study:
- To evaluate a novel linear probe-based POCUS examination for measuring cuffed TT location in children across a wide age range.
- To compare POCUS measurements with fluoroscopy measurements for pediatric tracheal tube tip localization.
- To assess the feasibility and accuracy of POCUS as an alternative to fluoroscopy for pediatric airway management.
Main Methods:
- A prospective study enrolled perioperative pediatric patients (<10 years) requiring a cuffed TT.
- Ultrasound and fluoroscopy images were obtained after routine TT placement.
- Measurements of TT cuff to cricoid cartilage (POCUS) and TT tip to carina (fluoroscopy) were compared after scaling for patient height.
Main Results:
- The POCUS examination successfully identified the TT cuff in all 41 enrolled patients with high image quality.
- The median POCUS examination time was 112 seconds.
- A strong correlation (r = -0.7575, p < 0.001) was found between POCUS and fluoroscopy measurements of TT location.
Conclusions:
- POCUS measurements of tracheal tube cuff location demonstrate a strong correlation with traditional fluoroscopy measurements.
- This linear probe-based POCUS technique is effective for pediatric tracheal tube localization across various ages.
- POCUS offers a reliable, radiation-free alternative for confirming tracheal tube placement in pediatric patients.
Introduction:
A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects' height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location.
Methods:
Perioperative pediatric patients (<10 years) requiring a cuffed TT were enrolled. After routine TT placement, ultrasound and fluoroscopy images were obtained. Measurements from the TT cuff to the cricoid cartilage were obtained from the POCUS examination. Chest fluoroscopy was reviewed to measure the TT's distance from the carina. Both measurements were then compared after scaling for patient height. The duration of the ultrasound examination and image quality scores were also recorded.
Results:
Forty-one patients were enrolled, with a median age of 3 (25th/75th percentile: 1.50/7.00) years. The POCUS examination identified the TT cuff in all cases with the highest image quality score. The median POCUS exam time was 112 (25th/75th percentile: 80.00/156.00) seconds. There was a strong correlation between the POCUS measurements and the fluoroscopy measurements, r = -0.7575, 95% CI [-0.8638, -0.5866 ], p < 0.001).
Conclusions:
Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.
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