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Ultrasonography for endotracheal tube position in infants and children

Abstract

Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults but has been less studied in infants and children. We review the literature regarding US for ETT positioning in the pediatric population. A literature search was conducted using the Ovid and MEDLINE databases with search terms regarding US relating to ETT intubation and positioning in infants and children. Most studies in neonates and infants used the midsagittal suprasternal view. Studies reported >80% visualization of the ETT tip by US, and US interpretation of the ETT position correlated with the XR position in 73–100% of cases. Studies of older children used the suprasternal views, substernal views, and mid-axillary intercostal views. US appears comparable to XR and capnography in determining ETT position in this population.

Conclusion: US for ETT verification appears to be well tolerated in infants and children and may augment determination of proper ETT position in combination with other ETT verification modalities. Further studies are needed regarding technique and training.

What is Known:
Point-of-care ultrasonography is realizing increased availability and use in several pediatric specialties.
Ultrasonography has been shown to be effective for verifying ETT position in adults but have been less studied in infants and children.
What is New:
Ultrasonography for endotracheal tube verification appears to be well tolerated in infants and children.
Ultrasonography may augment determination of proper endotracheal tube position in combination with other verification modalities such as radiography and capnography in the pediatric population.

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Abbreviations

ETT:

Endotracheal tube

NICU:

Neonatal intensive care unit

NPM:

Neonatal-perinatal medicine

NPV:

Negative predictive value

PCCM:

Pediatric critical care medicine

PED:

Pediatric emergency department

PEM:

Pediatric emergency medicine

PICU:

Pediatric intensive care unit

POCUS:

Point-of-care ultrasonography

PPV:

Positive predictive value

US:

Ultrasonography

XR:

Radiography

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Author information

Correspondence to Jimmy Nguyen.

Ethics declarations

The authors have no conflicts of interest relevant to this article to disclose. This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was not applicable.

Additional information

Communicated by Jaan Toelen

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Cite this article

Jaeel, P., Sheth, M. & Nguyen, J. Ultrasonography for endotracheal tube position in infants and children. Eur J Pediatr 176, 293–300 (2017). https://doi.org/10.1007/s00431-017-2848-5

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Keywords

  • Endotracheal intubation
  • Intubation
  • Neonatal-perinatal medicine
  • Neonatology
  • Point-of-care
  • Pediatric
  • Resuscitation
  • Ultrasonography
  • Ultrasound