Endotracheal Tube Position In Neonates Research Articles

Ultrasound assessment of endotracheal tube depth in neonates: a prospective feasibility study

ObjectiveTo examine the reliability of a novel ultrasound (US) method for assessment of endotracheal tube (ETT) position in neonates.DesignProspective, observational, single-centre, feasibility study.SettingLevel III neonatal intensive care unit.PatientsTerm and preterm...

'Lip-to-Tip' study: comparison of three methods to determine optimal insertion length of endotracheal tube in neonates.

The aim of this prospective observational study was to compare the incidence of endotracheal tube (ETT) malposition using weight-based (Tochen), gestation-based (Kempley), and nasotragal length (NTL) methods in deceased neonates and fresh stillbirths. We enrolled deceased neonates and fresh stillbirths within 2 ± 1 h of death or delivery, respectively; without hydrops, tracheostomy or major congenital anomalies affecting face, neck, or thorax. Each enrolled subject was intubated orotracheally, with lip-to-tip distance determined by three methods in random succession. Chest X-ray was acquired after each insertion. The primary outcome was proportion of malpositioned ETTs on chest X-ray (defined as ETT tip not lying between upper border of T1 and lower border of T2 vertebrae), assessed by two experts masked to the methods used. The proportion of malpositioned tubes was not significantly different with any of the three methods: (weight 27/50 (54%), gestation 35/50 (70%), and NTL 35/50 (70%), p value 0.055). The malpositioned tubes were too far in (87/150; 58%) than too far out (10/150; 6.7%).Conclusions: None of the currently recommended methods accurately predicts optimal ETT length in neonates. There is an urgent need for newer bedside modalities for estimating ETT position in neonates. What is known? • NRP guidelines recommend gestation-based and nasotragal length (NTL) methods to estimate initial ETT depth in neonates. Weight-based (Tochen) method is still widely used in neonatal units for ETT depth estimation. Evidence till date has not proven superiority of one method over the other. What is new? • All three methods for ETT depth estimation (Tochen, gestation-based, and NTL) resulted in high rates of ETT malposition in neonates. Formulae, devised from this study based on linear regression models, did not perform well for estimation of optimal ETT position.

A prospective observational trial evaluating factors predictive of accurate endotracheal tube positioning in neonates and small infants.

There is a high incidence of endotracheal tube malposition in neonates and small infants. Yet, verification of accurate endotracheal tube location via radiographic imaging involves radiation exposure. This study aimed to identify demographic and clinical parameters associated with accurate endotracheal tube positioning. We conducted a prospective single-center study with term and preterm neonates and small infants between January 2018 and November 2019. We investigated correlations between ten variables and accurate endotracheal tube position. One hundred and sixty eight nasal intubations in 139 patients (weight 390-5000g) were analyzed. An accurate tube position was confirmed by radiographic imaging in 71.4% of the intubations. The endotracheal tube was high in 8.3% and low in 20.2% of the cases. Male gender was the only variable that significantly correlated with an accurate endotracheal tube position (OR 2.5; 95% CI: 1.3, 5.0; P=.010). So far, no parameter has proven to be able to predict accurate endotracheal tube position in neonates reliably. These findings emphasize the indispensability of postintubation imaging in neonates and small infants.

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Comprehensive Overview of Pediatric Airway Management

Pediatric endotracheal intubation is a procedure that can be stress provoking to the emergency physician. Although the need for this core skill is rare, when confronted with this situation, the emergency physician must have knowledge of the anatomic, physiologic, and pathologic components unique to the pediatric airway to optimize success. Furthermore, the emergency physician should be well versed in the various equipment and adjuncts as well as techniques developed to effectively manage the pediatric airway. This review covers the pathophysiology and practice of endotracheal intubation. Figures show a gum elastic bougie; the Mallampati classification; appropriate oropharyngeal, laryngeal, and tracheal axes; advancing the laryngoscope to lift the epiglottis; endotracheal tube position in neonates; and synchronized intermittent mandatory ventilation pressure-regulated volume control mechanical ventilation. Tables list endotracheal tube sizes, neonatal endotracheal tube sizes, pediatric laryngeal mask airway sizes, commonly used induction agents, and endotracheal tube insertion depth guidelines. This review contains 6 figures, 8 tables, and 77 references. Key words: emergent tracheal intubation; endotracheal tube; laryngoscopy; pediatric airway; pediatric airway management; pediatric endotracheal intubation; pediatric laryngeal mask; video laryngoscopy

Accuracy of ultrasound in verifying endotracheal tube position in neonates

Objective To evaluate the accuracy of ultrasound in verifying endotracheal tube (ETT) position in neonates. Methods Sixty neonates of both sexes, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ , aged 2-28 days, weighing 2.5-4.8 kg, scheduled for urachal fistula/urachal resection or inguinal hernia repair under general anesthesia, were divided into 2 groups (n=30 each) using a random number table method: auscultation group and ultrasound group.Confirmation of ETT position was performed in two stages.In the first stage, misplacement of ETT into esophagus was identified using auscultation and ultrasound techniques after intubation, and end-tidal carbon dioxide pressure was considered as the gold standard for identification of esophageal intubation.In the second stage, misplacement of ETT into bronchus was identified using auscultation and ultrasound after confirming ETT position was within the trachea, and electronic bronchoscope served as the gold standard for identification of bronchial intubation. Results Compared with auscultation group, the accurate rate of identification of bronchial intubation was significantly increased in ultrasound group (P<0.05). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of auscultation for identification of esophageal intubation was 100%, 96.3%, 75% and 100%, respectively.The sensitivity, specificity, PPV and NPV of auscultation for identification of bronchial intubation was 33.3%, 95.8%, 66.7% and 85.2%, respectively.The sensitivity, specificity, PPV and NPV of ultrasound for identification of esophageal or bronchial intubation were all 100%. Conclusion Ultrasound can verify ETT position accurately in neonates. Key words: Ultrasonography; Intubation, intratracheal; Infant, newborn

Ultrasonography for Verification of Endotracheal Tube Position in Neonates and Infants.

Objective Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults and older children but has been less studied in the neonates and infants. The literature regarding US utility for ETT positioning in this population is reviewed. Study Design A literature search was conducted using the EMBASE, Google Scholar, MEDLINE, Ovid, and Scopus databases with search terms regarding US relating to ETT intubation and positioning in neonates and infants. Result Nine relevant studies were included for review. All studies report > 80% visualization of the ETT tip by US. US interpretation of the ETT position correlated with the radiography position in 73 to 100% of cases when the ETT tip was visible. There were variations in technique, sonographer, and sonographer training between studies. Conclusion US appears to be well tolerated by neonates and infants and may augment the determination of proper ETT position. Further studies are needed regarding optimal technique and sonographer training.

Digital palpation of endotracheal tube tip as a method of confirming endotracheal tube position in neonates: an open‐label, three‐armed randomized controlled trial

To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip. Open-label, randomized controlled trial (RCT). Level III neonatal intensive care unit (NICU). All newborn babies admitted in NICU requiring intubation. Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained. Rate of malposition of ETT as judged on chest X-ray (CXR). Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique. Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates.

Ultrasound Confirmation of Endotracheal Tube Position in Neonates

Background: The placement of the endotracheal tube (ETT) in neonates is a challenging procedure that currently requires timely confirmation of tip placement by radiographic imaging. Objective: We sought to determine if bedside ultrasound (US) could demonstrate ETT tip location in preterm and term newborns and offer a quick alternative method of ETT positioning. Methods: We conducted a prospective pilot study of 30 newborns admitted to the UC San Diego Medical Center who had their ETT placement confirmed by chest radiographs. After a radiograph, each infant had a US exam with a 13-MHz linear transducer on a portable US machine. To assist localization, gentle longitudinal movement of the ETT of less than 0.5 cm was performed. Measurements from the tip of the ETT tip to the carina were made on chest radiograph and midsagittal US images. Results: Study infants had a mean gestational age of 30.2 ± 4.9 (SD) weeks and mean birth weight of 1,595.2 ± 862 g. US images were taken a mean 2.9 ± 2.2 h after radiographs. Data from 2 infants were excluded for poor radiograph image quality and extreme outlier values. The ETT was visualized by US in all newborns examined. We observed a good correlation between ETT tip-to-carina distance on US and radiograph (r² = 0.68) with minimal bias. Each study took less than 5 min to obtain without any clinical deterioration. Conclusions: Bedside US can visualize the anatomic position of the ETT position in preterm and term infants but further validation is required before routine clinical implementation.

The use of the Beck Airway Airflow Monitor for verifying intratracheal endotracheal tube placement in patients in the pediatric emergency department and intensive care unit.

Traditional methods of confirming that the endotracheal tube is in the trachea are often unavailable or difficult to perform in some clinical situations, such as interfacility transport or other times outside the neonatal intensive care unit. We evaluated the Beck Airway Airflow Monitor (BAAM), through which airflow makes a whistling sound, for its safety and efficacy in neonates. We studied 46 neonates ranging in weight from 0.6 to 3.7 kg. We found that the BAAM consistently produced the desired whistling sound signaling intratracheal placement of the endotracheal tube in all infants weighing above 1.5 kg. No adverse effects or complications were noted. The results support the safety and efficacy of the BAAM in confirming intratracheal endotracheal tube position in neonates.

Endotracheal Tube Position in Neonates

Sir .—The recent study of Rotschild et al 1 provides useful data for predicting the length of endotracheal tube required in neonates from external measurements. In common with other studies in both adults 2 and neonates, 3-5 Rotschild et al found that correct endotracheal tube positioning is dependent on the state of flexion or extension of the neck. Whether endotracheal tube is confirmed with radiography, palpation, 6 ultrasonography, 7 bronchoscopy, 8 transtracheal illumination, 9 or magnetic detection, 10 the of the head and neck relative to the trunk is crucial to the interpretation of these estimations. Rotschild et al conclude their article by recommending that the infant's head be held in the neutral position when localizing of the tip of the endotracheal tube is attempted. The problem is ensuring that this neutral position is maintained from one examination to the next. We have addressed this question in our

Sonographic verification of endotracheal tube position in neonates: a modified technique.

Journal of Clinical UltrasoundVolume 16, Issue 8 p. 605-609 Technical Note Sonographic verification of endotracheal tube position in neonates: A modified technique Peter Allen Lingle MD, Corresponding Author Peter Allen Lingle MD Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University at Hurley Medical Center, Flint, MichiganDepartment of Pediatrics, One Hurley Plaza, Flint, Michigan 48502Search for more papers by this author Peter Allen Lingle MD, Corresponding Author Peter Allen Lingle MD Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University at Hurley Medical Center, Flint, MichiganDepartment of Pediatrics, One Hurley Plaza, Flint, Michigan 48502Search for more papers by this author First published: October 1988 https://doi.org/10.1002/jcu.1870160816Citations: 22AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume16, Issue8October 1988Pages 605-609 RelatedInformation