Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Abstract

Objective Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults and older children but has been less studied in the neonates and infants. The literature regarding US utility for ETT positioning in this population is reviewed.

Study Design A literature search was conducted using the EMBASE, Google Scholar, MEDLINE, Ovid, and Scopus databases with search terms regarding US relating to ETT intubation and positioning in neonates and infants.

Result Nine relevant studies were included for review. All studies report > 80% visualization of the ETT tip by US. US interpretation of the ETT position correlated with the radiography position in 73 to 100% of cases when the ETT tip was visible. There were variations in technique, sonographer, and sonographer training between studies.

Conclusion US appears to be well tolerated by neonates and infants and may augment the determination of proper ETT position. Further studies are needed regarding optimal technique and sonographer training.

Keywords

endotracheal tube - ultrasound - ultrasonography - point-of-care US - intubation - neonate - infant

• References

• 1 Rivera R, Tibballs J. Complications of endotracheal intubation and mechanical ventilation in infants and children. Crit Care Med 1992; 20 (2) 193-199
• 2 Schmölzer GM, Roehr CC. Techniques to ascertain correct endotracheal tube placement in neonates. Cochrane Database Syst Rev 2014; (9) CD010221
• 3 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364 (8) 749-757
• 4 Nguyen J, Amirnovin R, Ramanathan R, Noori S. The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 2016; 36 (11) 972-976
• 5 Nguyen J. Ultrasonography for central catheter placement in the neonatal intensive care unit—a review of utility and practicality. Am J Perinatol 2016; 33 (6) 525-530
• 6 Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics 2009; 123 (6) e1039-e1044
• 7 Galicinao J, Bush AJ, Godambe SA. Use of bedside ultrasonography for endotracheal tube placement in pediatric patients: a feasibility study. Pediatrics 2007; 120 (6) 1297-1303
• 8 Chou EH, Dickman E, Tsou PY , et al. Ultrasonography for confirmation of endotracheal tube placement: a systematic review and meta-analysis. Resuscitation 2015; 90: 97-103
• 9 Das SK, Choupoo NS, Haldar R, Lahkar A. Transtracheal ultrasound for verification of endotracheal tube placement: a systematic review and meta-analysis. Can J Anaesth 2015; 62 (4) 413-423
• 10 Slovis TL, Poland RL. Endotracheal tubes in neonates: sonographic positioning. Radiology 1986; 160 (1) 262-263
• 11 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 (2) 119-121
• 12 Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology 2012; 102 (3) 185-189
• 13 Alonso Quintela P, Oulego Erroz I, Mora Matilla M, Rodríguez Blanco S, Mata Zubillaga D, Regueras Santos L. [Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation]. An Pediatr (Barc) 2014; 81 (5) 283-288
• 14 de Kock SH, Otto SF, Joubert G. The feasibility of determining the position of an endotracheal tube in neonates by using bedside ultrasonography compared with chest radiographs. SAJCH 2015; 9 (1) 3-5
• 15 Lingle PA. Sonographic verification of endotracheal tube position in neonates: a modified technique. J Clin Ultrasound 1988; 16 (8) 605-609
• 16 Koltunov I, Degtyareva M, Mazaev A , et al. The feasibility of ultrasound diagnostics in confirmation of endotracheal tube position in neonates. J Matern Fetal Neonatal Med 2016; 29 (Supp 1)
• 17 Chowdhry R, Dangman B, Pinheiro JM. The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates. J Perinatol 2015; 35 (7) 481-484
• 18 Saul D, Ajayi S, Schutzman DL, Horrow MM. Sonography for complete evaluation of neonatal intensive care unit central support devices: a pilot study. J Ultrasound Med 2016; 35 (7) 1465-1473
• 19 Donadieu J, Zeghnoun A, Roudier C , et al. Cumulative effective doses delivered by radiographs to preterm infants in a neonatal intensive care unit. Pediatrics 2006; 117 (3) 882-888
• 20 Berrington de González A, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004; 363 (9406): 345-351
• 21 Hall P, Adami HO, Trichopoulos D , et al. Effect of low doses of ionising radiation in infancy on cognitive function in adulthood: Swedish population based cohort study. BMJ 2004; 328 (7430): 19-24
• 22 Ho T, Dukhovny D, Zupancic JA, Goldmann DA, Horbar JD, Pursley DM. Choosing wisely in newborn medicine: five opportunities to increase value. Pediatrics 2015; 136 (2) e482-e489
• 23 Hatch LD, Grubb PH, Lea AS , et al. Endotracheal intubation in neonates: a prospective study of adverse safety events in 162 infants. J Pediatr 2016; 168 (6) 62-66.e6
• 24 Dinh VA, Giri PC, Rathinavel I , et al. Impact of a 2-day critical care ultrasound course during fellowship training: a pilot study. Crit Care Res Pract 2015; 2015 (1) 675041 . Doi:10.1155/2015/675041
• 25 Spurney CF, Sable CA, Berger JT, Martin GR. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr 2005; 18 (4) 313-319
• 26 Conlon TW, Himebauch AS, Fitzgerald JC , et al. Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med 2015; 16 (3) 219-226