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Am J Perinatol 2024; 41(S 01): e2886-e2892
DOI: 10.1055/a-2181-7354
Original Article

Point-of-Care Ultrasound for the Tip of the Endotracheal Tube: A Neonatologist Perspective

Ozlem Sahin
1   Department of Neonatology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
,
Sevinc Tasar
2   Department of Radiology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
,
Derya Colak
1   Department of Neonatology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
,
Funda Yavanoglu Atay
1   Department of Neonatology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
,
Omer Guran
1   Department of Neonatology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
,
Ilke Mungan Akin
1   Department of Neonatology, Health Sciences University, Umraniye Training and Research Hospital, Istanbul, Türkiye
› Author Affiliations
Funding None.
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Abstract

Objective Point-of-care ultrasound (POCUS) has been reported to reduce radiation exposure and has been shown to be a reliable bedside technique to confirm endotracheal tube (ETT) placement, but evidence in neonates is still limited. The aim of this study was to compare the effectiveness and reliability of POCUS performed by a neonatologist, as an alternative to chest radiography (CXR) for the optimal position of ETT.

Study Design Newborns who underwent intubation were included in this prospective observational study. The CXR was used to evaluate the position of the ETT tip and categorized into three groups: above the T1, between the T1 and T3, and below the T3 vertebra. An experienced neonatologist measured the distance between the ETT tip and the upper border of the aortic arch from the suprasternal notch with ultrasonography (US). A 5 to 10 mm measurement was considered as the optimal distance, and the position was classified into three categories: correct, high, and deep.

Results Among 91 measurements performed on 63 intubated patients with US, 73 (80%) were within the 5 to 10 mm range (correct position). Of these, 61 (92.4%) were determined to be between T1 and 3 vertebrae in CXR. There was no significant difference between the two methods, and the US had an excellent ability to distinguish the correct position of the ETT. The distance measured by the US for the ETT tip to be located between the T1 and T3 vertebrae on CXR should range between 6.17 and 9.0 mm.

Conclusion This study showed that the US by an experienced neonatologist is an easy and feasible alternative to determine the position of the ETT in the neonatal intensive care unit.

Key Points

  • POCUS has been reported to reduce radiation exposure, and it is areliable bedside technique.

  • Evidence for confirmation of ETT placement in neonates is limited.

  • POCUS can be used for determination of ETT position in NICU's by experienced neonatologists.

Keywords

neonate - intubation - point-of-care ultrasound - chest radiography

Ethical Approval

Approval for this study was obtained from the hospital's ethics committee on (16.12.2021) with the reference number (identifier: B.10.1.TKH.4.34.H.GP.0.01/345). Written informed consent was obtained from the parents of each participant before US. Infants who did not have parental consent were excluded from the study.




Publication History

Received: 04 May 2023

Accepted: 25 September 2023

Accepted Manuscript online:
26 September 2023

Article published online:
31 October 2023

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