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Assessment of the Endotracheal Tube Tip Position by Bedside Ultrasound in a Pediatric Intensive Care Unit: A
Seenivasan Subramani1, Narayanan Parameswaran2, Ramesh Ananthkrishnan3
1Department of Pediatric Intensive Care, Madras Medical College, Chennai, Tamil Nadu, India.
Insights
Bedside ultrasound (USG) can accurately assess endotracheal tube (ETT) tip position in ventilated children, showing high sensitivity. However, its specificity is limited, making it a useful but not definitive tool for ETT placement in the Pediatric Intensive Care Unit (PICU).
Area of Science:
- Pediatric Critical Care Medicine
- Medical Imaging
- Ultrasound Technology
Background:
- Chest X-ray (CXR) is the standard for verifying endotracheal tube (ETT) tip position in pediatric patients but involves delays and radiation.
- Bedside ultrasound (USG) offers a potential alternative to CXR for ETT tip assessment in the Pediatric Intensive Care Unit (PICU).
Observation:
- A prospective study compared bedside ultrasound (USG) with CXR in 135 children (1-60 months) requiring intubation.
- USG measured the distance from the ETT tip to the aortic arch, compared to ETT tip to carina distance on CXR.
- The reliability of repeated USG measurements was high (ICC = 0.986).
Findings:
- Bedside USG demonstrated high sensitivity (98.10%) in correctly identifying ETT tip position.
- Specificity of USG was found to be lower (50.0%) compared to CXR.
- USG provides a reliable assessment of ETT tip location in ventilated pediatric patients.
Implications:
- Bedside ultrasound offers a promising, radiation-free alternative for rapid ETT tip assessment in PICU settings.
- While highly sensitive, the limitations in specificity suggest USG may complement, rather than entirely replace, CXR in certain scenarios.
- Further research could refine USG protocols to improve specificity for ETT tip verification.
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%).
How To Cite This Article:
Subramani S, Parameswaran N, Ananthkrishnan R, Abraham S, Chidambaram M, Rameshkumar R, et al. 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.
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