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Am J Perinatol 2017; 34(07): 627-632
DOI: 10.1055/s-0036-1597846
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants

Mansi Sheth
1   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Pooja Jaeel
1   Keck School of Medicine, University of Southern California, Los Angeles, California
,
Jimmy Nguyen
2   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, California
3   Division of Neonatal-Perinatal Medicine, Center for Fetal and Neonatal Medicine, Children's Hospital Los Angeles, University of Southern California, Los Angeles, California
› Author Affiliations
Further Information

Publication History

30 August 2016

28 November 2016

Publication Date:
28 December 2016 (online)

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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
    CrossrefPubMedGoogle Scholar
  • 2 Schmölzer GM, Roehr CC. Techniques to ascertain correct endotracheal tube placement in neonates. Cochrane Database Syst Rev 2014; (9) CD010221 DOI: 10.1002/14651858.CD010221.pub2.
    PubMedGoogle Scholar
  • 3 Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011; 364 (8) 749-757
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 10 Slovis TL, Poland RL. Endotracheal tubes in neonates: sonographic positioning. Radiology 1986; 160 (1) 262-263
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Dennington D, Vali P, Finer NN, Kim JH. Ultrasound confirmation of endotracheal tube position in neonates. Neonatology 2012; 102 (3) 185-189
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Lingle PA. Sonographic verification of endotracheal tube position in neonates: a modified technique. J Clin Ultrasound 1988; 16 (8) 605-609
    CrossrefPubMedGoogle Scholar
  • 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) DOI: 10.1080/14767058.2016.1191212.
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar