Abstract
Introduction: A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. After adjusting for the subjects’ height and TT size, ultrasound measurements of the TT cuff location were compared with fluoroscopy measurements of the TT tip location. Methods: Perioperative pediatric patients (<10 years) requiring a cuffed TT were enrolled. After routine TT placement, ultrasound and fluoroscopy images were obtained. Measurements from the TT cuff to the cricoid cartilage were obtained from the POCUS examination. Chest fluoroscopy was reviewed to measure the TT’s distance from the carina. Both measurements were then compared after scaling for patient height. The duration of the ultrasound examination and image quality scores were also recorded. Results: Forty-one patients were enrolled, with a median age of 3 (25th/75th percentile: 1.50/7.00) years. The POCUS examination identified the TT cuff in all cases with the highest image quality score. The median POCUS exam time was 112 (25th/75th percentile: 80.00/156.00) seconds. There was a strong correlation between the POCUS measurements and the fluoroscopy measurements, r = −0.7575, 95% CI [−0.8638, −0.5866 ], p < 0.001). Conclusions: Our results demonstrate a strong correlation between POCUS TT localization measurements and traditional measurements via fluoroscopy. This study further supports the utility of POCUS for pediatric care.
Highlights
A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure
Of the nine subjects excluded from the study, four did not have their fluoroscopy images saved into the EMR system and five received a laryngeal mask airway instead of a TT
This study further supports the utility of Point-of-care ultrasound (POCUS) for evaluating TT position and providing a method of measuring the location of the TT within the trachea over a wide age range of pediatric patients
Summary
A non-radiographic technique to measure the location of the tracheal tube (TT) in children is of value given the risk of inappropriate TT placement along with concerns about radiation exposure. Airway point-of-care ultrasound (POCUS) has demonstrated utility in children, but the examinations vary by age and may require non-traditional techniques or utilize less common probes. This study evaluated the performance of measuring the tracheal location of the cuffed TT using a novel, linear probe-based POCUS examination over a wide age range of children. Other techniques used to evaluate appropriate TT placement include: (1) age/height-based formulas, (2) palpation of the trachea, (3) the evaluation of TT pilot balloon distention with sternal notch palpation, and (4) fluoroscopy/chest x-ray. Each of these techniques has limitations [7,8]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have