P Alonso Quintela1, I Oulego Erroz2, M Mora Matilla3, S Rodríguez Blanco4, D Mata Zubillaga5, L Regueras Santos6. 1. Servicio Pediatría, Complejo Asistencial Universitario de León, León, España. Electronic address: paulaalonsoquintela@gmail.com. 2. Servicio de Cardiología, Complejo Asistencial Universitario de León, León, España; Unidad de Cuidados Intensivos Pediátricos, Complejo Asistencial Universitario de León, León, España. 3. Servicio Pediatría, Complejo Asistencial Universitario de León, León, España. 4. Servicio de Neonatología, Complejo Asistencial Universitario de León, León, España; Unidad de Cuidados Intensivos Pediátricos, Complejo Asistencial Universitario de León, León, España. 5. Centro de Salud Ponferrada IV, Complejo Asistencial Universitario de León, León, España. 6. Unidad de Cuidados Intensivos Pediátricos, Complejo Asistencial Universitario de León, León, España.
Abstract
OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.
OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.
Authors: Harsha K Chandnani; Ivanna N Maxson; Disha K Mittal; Salem Dehom; Anthony Moretti; Vi A Dinh; Merrick Lopez; Janeth C Ejike Journal: J Pediatr Intensive Care Date: 2020-08-20
Authors: Hasan S Merali; Mark O Tessaro; Khushboo Q Ali; Shaun K Morris; Sajid B Soofi; Shabina Ariff Journal: BMC Pediatr Date: 2019-11-13 Impact factor: 2.125