Emergency Identification of Endotracheal Tube Tip via Ultrasonography Used by Trained Nurse in the Neonatal Intensive Care Unit (NICU)

Background: Endotracheal tube (ETT) placement is crucial for neonates with respiratory failure. Ultrasonography (US) has emerged as a valuable tool to detect ETT positioning, competing with traditional methods. Nurses, being front-line caregivers, can perform basic ultrasound examinations. This study aimed to assess whether a nurse inexperienced in US could identify the correct ETT position in neonates after a brief ultrasound training. Methods: This study included intubated neonates hospitalized in a NICU with a postmenstrual age of under 45 weeks. A NICU nurse, following a short ultrasound training, measured the distance of the ETT tip to the right pulmonary artery and aortic arch. Chest X-rays (CXRs) confirmed the ETT position. The neonates' ages, genders, weights, and examination times were recorded. Results: This study involved 67 neonates, including 40 (59.7%) males, with 39 (58.2%) weighing below 1500 g. The median time for correct ETT placement confirmation by CXR was 12.6 min, while US-assisted ETT recognition took 6 min initially and 5.1 min at the end of the training, which was a significant difference. No major differences were found in US distance based on the neonate's weight and age. Gender marginally influenced US distance (β = -0.089, p = 0.056). Conclusions: The NICU nurse responded well to ultrasound training, showing results comparable with CXR. Further studies with more patients and additional studied factors are needed to fully assess US's reliability in determining ETT positioning.