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Research article
The feasibility of bedside ultrasound in confirmation of Endotracheal tube position in neonates compared with CXR
Elham Zarei
Iran University of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2130-405X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background:
Endotracheal intubation is a common procedure in the neonatal intensive care unit (NICU). Rapid and accurate confirmation of the endotracheal tube (ETT) position is critical . Routinely CXR is used for evaluation of ETT position that has some disadvantages . So there has been a considerable interest to find alternative modality with minimal complication and acceptable accuracy.
The purpose of our study is the evaluation of ultrasound efficacy in confirmation of ETT position in neonates comparison to CXR.
Methods: This cross-sectional study was conducted on 66 intubated neonates in NICU of Ali -Asghar children Hospital, between January 2018 and January 2019. To determine the ETT position, CXR and ultrasound were requested at the same time and only patients who could have an ultrasound immediately after intubation and without repositioning of tracheal tube between CXR and ultrasound were included in the study .Each neonate had a bedside ultrasound (US) with a high-frequency linear transducer. Accuracy, sensitivity, specificity, negative predicted value (NPV), positive predicted value (PPV) and Kappa agreement coefficient was used to compare the US and CXR results.
Results: Sixty-six intubated neonates included in this study had a mean gestational age of 34.98 ±3.7 weeks and mean birth weight of 2284.7 ± 915g. US images were taken a mean of 3 ±0.6 h after CXR. The ETT was visualized by the US in all newborns examined.US revealed a sensitivity of 88% (95% CI, 68.78% to 97.45%), specificity of 84 % (95% CI, 63.92% 95.46%), PPV of 84.62% (95% CI, 68.89% to 93.18%), NPV of 87.50 % (95% CI, 70.49% to 95.35%), diagnostic accuracy of 86%(95% CI, 73.26% to 94.18%), positive likelihood ratio of 5.50 (95% CI 2.21 to 13.66), and Negative Likelihood Ratio of 0.14 (95% CI 0.05 to 0.46) compared to chest radiography. Overall, the Kappa value showed very good agreement in confirming the correct position of the tracheal tube placement (Kappa coefficient 0.72, p-value <0.001).The mean time taken for confirmation of ETT position by US 4 minutes and by CXR was 20 minutes.
Conclusion: The findings of this study demonstrate ultrasound has acceptable accuracy for confirmation of ETT position in neonates and is a safer and faster method in comparison to CXR .
Keywords
Bedside Ultrasonography, Chest X-ray, Endotracheal intubation
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CURRENT STATUS: Under Review
Version 3
Posted 11 Jan, 2021
No community comments so far
Review #1 received
Received 09 Jan, 2021
Reviewer #2 agreed
On 03 Jan, 2021
Review #2 received
Received 03 Jan, 2021
Reviewers invited
Invitations sent on 02 Jan, 2021
Reviewer #1 agreed
On 02 Jan, 2021
Editor assigned
On 26 Dec, 2020
Submission checks complete
On 26 Dec, 2020
Editor invited
On 26 Dec, 2020
No comments provided
Review #2 received
Received 22 Nov, 2020
Editorial decision: Major revision
On 22 Nov, 2020
Reviewer #2 agreed
On 01 Nov, 2020
Review #1 received
Received 30 Oct, 2020
Editor assigned
On 26 Oct, 2020
Reviewers invited
Invitations sent on 26 Oct, 2020
Reviewer #1 agreed
On 26 Oct, 2020
Editor invited
On 25 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Community comments: 6
Editorial decision: Major revision
On 30 Sep, 2020
Review #2 received
Received 28 Sep, 2020
Reviewer #2 agreed
On 18 Sep, 2020
Review #1 received
Received 31 Aug, 2020
Reviewer #1 agreed
On 28 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
First submitted
On 26 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
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This preprint is under consideration at BMC Pediatrics. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
The feasibility of bedside ultrasound in confirmation of Endotracheal tube position in neonates compared with CXR
Elham Zarei
Iran University of Medical Sciences
Corresponding Author
ORCiD: https://orcid.org/0000-0002-2130-405X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 3
Posted 11 Jan, 2021
No community comments so far
Review #1 received
Received 09 Jan, 2021
Reviewer #2 agreed
On 03 Jan, 2021
Review #2 received
Received 03 Jan, 2021
Reviewers invited
Invitations sent on 02 Jan, 2021
Reviewer #1 agreed
On 02 Jan, 2021
Editor assigned
On 26 Dec, 2020
Submission checks complete
On 26 Dec, 2020
Editor invited
On 26 Dec, 2020
No comments provided
Review #2 received
Received 22 Nov, 2020
Editorial decision: Major revision
On 22 Nov, 2020
Reviewer #2 agreed
On 01 Nov, 2020
Review #1 received
Received 30 Oct, 2020
Editor assigned
On 26 Oct, 2020
Reviewers invited
Invitations sent on 26 Oct, 2020
Reviewer #1 agreed
On 26 Oct, 2020
Editor invited
On 25 Oct, 2020
Submission checks complete
On 25 Oct, 2020
Community comments: 6
Editorial decision: Major revision
On 30 Sep, 2020
Review #2 received
Received 28 Sep, 2020
Reviewer #2 agreed
On 18 Sep, 2020
Review #1 received
Received 31 Aug, 2020
Reviewer #1 agreed
On 28 Aug, 2020
Reviewers invited
Invitations sent on 06 Aug, 2020
Editor assigned
On 28 Jul, 2020
Submission checks complete
On 27 Jul, 2020
Editor invited
On 27 Jul, 2020
First submitted
On 26 Jul, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Pediatrics
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background:
Endotracheal intubation is a common procedure in the neonatal intensive care unit (NICU). Rapid and accurate confirmation of the endotracheal tube (ETT) position is critical . Routinely CXR is used for evaluation of ETT position that has some disadvantages . So there has been a considerable interest to find alternative modality with minimal complication and acceptable accuracy.
The purpose of our study is the evaluation of ultrasound efficacy in confirmation of ETT position in neonates comparison to CXR.
Methods: This cross-sectional study was conducted on 66 intubated neonates in NICU of Ali -Asghar children Hospital, between January 2018 and January 2019. To determine the ETT position, CXR and ultrasound were requested at the same time and only patients who could have an ultrasound immediately after intubation and without repositioning of tracheal tube between CXR and ultrasound were included in the study .Each neonate had a bedside ultrasound (US) with a high-frequency linear transducer. Accuracy, sensitivity, specificity, negative predicted value (NPV), positive predicted value (PPV) and Kappa agreement coefficient was used to compare the US and CXR results.
Results: Sixty-six intubated neonates included in this study had a mean gestational age of 34.98 ±3.7 weeks and mean birth weight of 2284.7 ± 915g. US images were taken a mean of 3 ±0.6 h after CXR. The ETT was visualized by the US in all newborns examined.US revealed a sensitivity of 88% (95% CI, 68.78% to 97.45%), specificity of 84 % (95% CI, 63.92% 95.46%), PPV of 84.62% (95% CI, 68.89% to 93.18%), NPV of 87.50 % (95% CI, 70.49% to 95.35%), diagnostic accuracy of 86%(95% CI, 73.26% to 94.18%), positive likelihood ratio of 5.50 (95% CI 2.21 to 13.66), and Negative Likelihood Ratio of 0.14 (95% CI 0.05 to 0.46) compared to chest radiography. Overall, the Kappa value showed very good agreement in confirming the correct position of the tracheal tube placement (Kappa coefficient 0.72, p-value <0.001).The mean time taken for confirmation of ETT position by US 4 minutes and by CXR was 20 minutes.
Conclusion: The findings of this study demonstrate ultrasound has acceptable accuracy for confirmation of ETT position in neonates and is a safer and faster method in comparison to CXR .