The feasibility of bedside ultrasound in confirmation of Endotracheal tube position in neonates compared with CXR
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 .
Posted 11 Jan, 2021
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The feasibility of bedside ultrasound in confirmation of Endotracheal tube position in neonates compared with CXR
Posted 11 Jan, 2021
Received 09 Jan, 2021
On 03 Jan, 2021
Received 03 Jan, 2021
Invitations sent on 02 Jan, 2021
On 02 Jan, 2021
On 26 Dec, 2020
On 26 Dec, 2020
On 26 Dec, 2020
Received 22 Nov, 2020
On 22 Nov, 2020
On 01 Nov, 2020
Received 30 Oct, 2020
On 26 Oct, 2020
Invitations sent on 26 Oct, 2020
On 26 Oct, 2020
On 25 Oct, 2020
On 25 Oct, 2020
On 30 Sep, 2020
Received 28 Sep, 2020
On 18 Sep, 2020
Received 31 Aug, 2020
On 28 Aug, 2020
Invitations sent on 06 Aug, 2020
On 28 Jul, 2020
On 27 Jul, 2020
On 27 Jul, 2020
On 26 Jul, 2020
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 .