Tube Position Research Articles

Ultrasonography Imaging versus Waveform Capnography in Detecting Endotracheal Tube Placement during Intubation at a Tertiary Hospital.

There is continued research to find new faster, highly accurate, easily accessible, and portable methods of confirming endotracheal tube position during intubation. A newer modality for visualizing endotracheal tube location is transtracheal or transcricothyroid ultrasonography. The aim of this study was to see if ultrasound machine can also be routinely used for the confirmation of endotracheal tube position in operating theaters along with capnograph. The study was observational and prospective, conducted from January 2017 to July 2017. Study locations were at the Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center operating rooms. Sample size taken was 95. In the study, 11 patients had esophageal intubation out of the 95. The accuracy of both ultrasonography and capnography was found to be 96.84%. For ultrasonography, the sensitivity, specificity, along with positive predictive value and negative predictive value were 97.62%, 90.91%, 98.80%, and 83.33%, respectively, while that for capnography were found to be 96.43%, 100%, 100%, and 78.57%, respectively. The kappa value was calculated to be 0.749, which suggested the degree of agreement of result between the methods to be good. Compared to capnography, ultrasonography was found to be significantly faster for the confirmation of endotracheal tube location by 16.36 s (15.70-17.02) (P = 0.011). Both waveform capnography and ultrasonography were found to be accurate and reliable in confirming endotracheal tube location. The use of ultrasound during intubation can help confirm endotracheal tube location faster and also aid in precision when used along with capnography. Manual bag ventilations are not necessary when confirming endotracheal tube position by ultrasonography and thus may help in preventing aspiration of gastric contents into the lungs of the patient.

Numerical investigation of heat transfer and melting process of phase change material in trapezoidal cavities with different shapes and different heated tube positions

Numerical investigation of heat transfer and melting process of phase change material in trapezoidal cavities with different shapes and different heated tube positions

Analysis of thermally-induced displacements of the HartRAO Lunar Laser Ranger optical tube: impact on pointing

The Hartebeesthoek Radio Astronomy Observatory (HartRAO) of South Africa is developing a Lunar Laser Ranging (LLR) system to achieve sub-centimetre range precision to the Moon. Key to this high precision expectation, which includes improving the overall operational performance of its telescope, is the thermal analysis of the telescope structure. In this study, thermal sensors were mounted on the thermally- important areas of the tube structure to measure the tube displacements emanating from the varying ambient air temperatures. A laser distance-measurement system was used for this purpose. Results showed that while the optical tube undergoes structural changes with changes in temperature, the tube position closer to the place where the spider assembly is mounted is unevenly displaced in three directions. In particular, for the time period considered in this study, it was found that the relative displacements on average at prisms 1, 2 and 3 in the vertical direction were 2.5540 ± 0.0007 m, 1.3750 ± 0.0008 m and 1.9780 ± 0.0007 m, respectively. The corresponding standard deviation (SD) values of ±0.0007 m, ±0.0008 m and ±0.0007 m denotes the average deviations that occurred in the vertical direction at the centre of prisms 1, 2 and 3, respectively. The generally higher SD of relative displacements in the vertical direction rather than in the easting and northing directions, suggest that the tube experienced greater variations in the vertical direction. Furthermore, the lower arc of the tube front, was found to have increased variability, and therefore it was hypothesised to introduce more elevation pointing offsets than azimuth for the LLR. This information constitutes an important input for guiding the efforts to determine the extent of the correction needed to be fed into the LLR telescope pointing model to counteract expected thermally induced pointing offsets.

Maximization of performance of a PCM latent heat storage system with innovative cavity shape and optimum heating tube position

Maximization of performance of a PCM latent heat storage system with innovative cavity shape and optimum heating tube position

New Imaging Protocol to Assess Endotracheal Tube Placement: A Case-control Study.

After intubation, a frontal chest radiograph (CXR) is obtained to assess the endotracheal tube (ETT) position by measuring the ETT tip-to-carina distance. ETT tip location changes with neck position and can be determined by assessing the position of the mandible. As the mandible is typically not visualized on standard CXRs, we developed a new protocol where the mandible is seen on the CXR, hypothesizing that it will improve the accuracy of the ETT position assessment. Two groups of intubated patients studied (February 9, 2021 to May 4, 2021): CXR taken in either standard or new protocol (visible mandible required). Two observers independently assessed the images for the neck position (neutral, flexed, and extended) based on the mandible position relative to the vertebral bodies. With the mandible absent (ie, neck position unknown), we established terms: "gray zone" (difficult to assess the ETT position adequately) and "clear zone" (confident recommendation to retract, advance, or maintain ETT position). We compared the rate of confident assessment of the ETT in the standard versus the new protocol. Of 308 patients, 155 had standard CXRs and 153 had the new protocol. Interrater agreements for the distance between the ETT and the carina and mandible height based on vertebral bodies were 0.986 (P < 0.001) and 0.955 (P < 0.001), respectively. The mandible was visualized significantly more often (P < 0.001) with the new protocol (92%; 141/153) than with the standard protocol (21%; 32/155). By visualizing the mandible or the presence of the ETT within the clear zone, a reader could confidently assess the ETT position more often using the new protocol (96.7% vs 51.6%, P < 0.001). Mandible visibility on postintubation CXR is helpful for assessing the ETT position. The new protocol resulted in a significant increase in both visualizing the mandible and accurately determining ETT position on postintubation CXR.

Training approaches and devices utilization during endotracheal intubation in French Emergency Departments: a nationwide survey.

Endotracheal intubation is a lifesaving procedure that is reportedly associated to a significant risk of adverse events. Recent trials have reported that the use of videolaryngoscope and of a stylet might limit this risk during emergency intubation. The objective of this study was to provide a national description of intubation practices in French Emergency Departments (EDs). We conducted an online nationwide survey by sending an anonymous 37-item questionnaire via e-mail to 629 physicians in French EDs between 2020 and 2022. A single questionnaire was sent to a sole referent physician in each ED. The primary endpoint was to assess the proportion of French EDs in which videolaryngoscopy was available for emergency intubation and its use in routine practice. Secondary endpoints included the presence of local protocol or standard of procedure for intubation, availability of capnography, and routine use of a stylet. Of the surveyed EDs, 342 (54.4%) returned the completed questionnaire. A videolaryngoscope was available in 193 (56%) EDs, and direct laryngoscopy without a stylet was majorly used as the primary approach in 280 (82%) EDs. Among the participating EDs, 74% had an established protocol for intubation and 92% provided a capnography device for routine verification of tube position. In cases of difficult intubation, the use of a bougie was recommended in 227 (81%) EDs, and a switch to a videolaryngoscope in 16 (6%) EDs. The most frequently used videolaryngoscope models were McGrath Mac Airtraq (51%), followed by Airtraq (41%), and Glidescope (14%). In this large French survey, the majority of EDs recommended direct laryngoscopy without stylet, with seldom use of videolaryngoscopy.

Electromagnetically Navigated Tube Placement Device for Bedside Placement of Small Bowel Feeding Tube on Patients with Acute Severe Pancreatitis: Comparative Study.

A developing approach for the bedside installation of feeding tubes is the Electromagnetic Navigation-assisted Tube Placement Device (ENTPD). The ENTPD monitors the tip position of feeding tubes when they are inserted into the digestive tract. It aids in the avoidance of airway misalignment and allows placing into the small bowel. Several recent exploratory studies have shown that ENTPD for nasojejunal feeding tube installation can improve success rates, lower costs, and allow for a more rapid beginning of enteral nutrition. The aim of this study was to compare the effect of using an ENTPD for bedside placement of small bowel feeding tubes with blind placement on patients with acute severe pancreatitis and to see how well the electromagnetic navigation trajectory image (ENTI) and X-ray agreed on the location of the tube tip after placement. The study was done prospectively using randomized and single-blind methods. The 65 cases used electromagnetic navigation-assisted placement, and 58 cases were blind placement. For judging the tube tip location, we compared the success rate, median time, number of repeat placements, complications, and agreement of ENTI vs. X-ray. The blind placement group's success rate was 86.21% compared to the ENTPD's 95.38%, P = 0.075. The median time was significantly longer in the blind placement group (116.55 ± 68.62 min vs. 25.37 ±12.63 min, P=0.000); the average number of repeating placements was 3.02 ± 1.21 vs. 1.16 ± 0.31 (Blind placement vs. ENTPD, P = 0.002). It provided a high degree of agreement between ENTI and X-ray after contrast, κ=0.752 [95% confidence interval, 0.67-0.84]. No complications occurred in the two groups. ENTPD was used safely and effectively at the bedside to help patients with acute severe pancreatitis get feeding tubes. It not only improved the high successful rate of placement, decreased the time and reduced the exposure to X-ray, but it was also very convenient for bedside placement because of the portable equipment.

A novel oval-shaped coaxial ground heat exchanger for augmenting the performance of ground-coupled heat pumps: Transient heat transfer performance and multi-parameter optimization

Ground-coupled heat pumps (GCHP) are highly impactful and promising systems for extracting geothermal energy. Nevertheless, the effectiveness of GCHP can be further improved by reshaping and optimizing the configuration of the coaxial ground heat exchanger (CGHE), which represents the core component of the GCHP and has a significant influence on the heat extraction performance of the system. This paper introduces a detailed comparative numerical study on a novel CGHE with an oval cross-section for enhancing the performance of the GCHP. The proposed design's simplicity stems from altering the outer tube to an oval shape, compared to the commercially used circular CGHE. The conjugate fluid flow and heat transfer are simulated utilizing a three-dimensional numerical model. Heat flux, GHE thermal resistance, and pressure drop within the tube are computed and analyzed. A comparison between circle and oval cross-sections is carried out. The adopted 3-D model shows a fit verification with their experimental pairs via a field experiment. Parametric study and sensitivity analysis are performed, and the effect of groundwater flow on heat transfer is also examined. An optimization approach is developed to explore the optimal inner tube position and incorporate multi-inner tubes that attain the maximum heat transfer efficiency of the oval-CGHE. The results reveal that oval-CGHE significantly surpasses the conventional circle-CGHE, improving the maximum and average heat transfer by 21.03% and 10.24%, corresponding to a reduction in thermal resistance by 28.83% and 9.06%, respectively. Additionally, optimizing the inner tube position and incorporating multi-inner tubes further enhances the performance of oval-CGHE by maximum and average heat transfer rates of 33.01% and 22.91% for inner tube position optimization and 39.08% and 28.84% for multi-inner tube optimization, respectively.

Experimental Investigation of Control Rod Drops Into Perturbed Fuel Assemblies

Abstract This paper discusses permanent deformation of the fuel assembly of pressurized water reactors that have to satisfy a drop time requirement of the control rod assembly. During a seismic event, the fuel assemblies and the reactor core exhibit transient vibration. When the fuel assemblies collide, they develop impact forces in the spacer grids along the fuel assemblies. If the impact forces on some spacer grids of the fuel assembly exceed an allowable strength, the buckling occurs in the corresponding spacer grids, followed by permanent deformation. The geometry change of the buckled spacer grids leads to the movement of the guide tube positions in the fuel assembly. Therefore the geometry change is associated with the distortion of the control rod drop path. In this study, the permanent deformation of the spacer grids was measured during the impact tests, and the maximum deviation of the guide tube from the original position was investigated. Control rod drop tests were also performed to measure the change in drop time according to the deformation of the fuel assembly. Using actuators in the loop test facility, the authors realized the first and second bending mode shapes of the fuel assembly under the flowing water condition. Based on a series of drop tests, the critical fuel assembly deformation was identified that could lead to a violation of an allowable drop time of the control rod.

Capnometry in the intensive care unit (literature review)

Capnometry/capnography is a method of measuring and displaying the concentration of carbon dioxide (CO2) in respiratory gases. Most often, this term involves measuring the partial pressure of carbon dioxide (PCO2) at the end of exhalation (end-tidal CO2, ETCO2). The curve formed during capnography is called a capnogram, where the inspiratory and expiratory segments are distinguished. The main determinants of ETCO2 are CO2 production, cardiac output, pulmonary perfusion, and alveolar ventilation. Normally, ETCO2 is 2–5 mm Hg lower than arterial blood PCO2. This gradient increases when the ventilation-perfusion ratio is impaired, for example, in pulmonary embolism or pulmonary hypoperfusion during cardiac arrest. The shape of the capnogram, in turn, depends on the concentration of CO2 in the alveoli and the pattern of their emptying, as well as on cardiac output. This allows the use of capnography to register bronchospasm, CO2 circulation in the circuit, spontaneous breathing attempts, etc. In Ukraine, capnometry and capnography are routinely used in the anesthesia during laparoscopic surgeries, which require strict control of ETCO2 due to the insufflation of CO2 into the abdominal cavity and its absorption by the peritoneum. However, the spectrum of capnometry application is actually much wider than just laparoscopic surgery. In the intensive care unit, it includes but is not limited to the following indications: confirmation of the endotracheal tube position during tracheal intubation; monitoring the respiratory circuit integrity, including while turning and transporting a patient; evaluation of the cardiopulmonary resuscitation effectiveness; evaluation of the mask ventilation effectiveness; breathing monitoring during procedural sedation; monitoring during mechanical ventilation; auxiliary monitoring of hemodynamics. This literature review discusses the advantages, disadvantages and methods of using capnometry/capnography for each of the listed indications in detail.

Analytical Review of Unplanned Extubation in Intensive Care Units and Recommendation on Multidisciplinary Preventive Approaches.

Unplanned extubations (UE) frequently occur in critical care units. These events are precipitated by many risk factors and are associated with adverse outcomes for patients. We reviewed the current literature to examine factors related to UE and presented the analysis of 41 articles critical to the topic. Our review has identified specific risk factors that we discuss in this review, such as sedation strategies, physical restraints, endotracheal tube position, and specific nursing care aspects associated with an increased incidence of UE. We recommend interventions to reduce the risk of UE. However, we recommend that bundled rather than a single intervention is likely to yield higher success, given the heterogeneity of factors contributing to increasing the risk of UE.

Influence of tube and patient positioning in thoracoabdominal CT examinations on radiation exposure–towards a better patient positioning

Although iso-centric patient positioning is enormously important in computed tomography (CT), it is complicated in thoracoabdominal imaging by the varying dimensions of the body. Patient positioning can affect the appearance of the patient on the localiser. Positioned too close to the x-ray tube, a patient appears considerably more voluminous. The goal of this study is to assess the difference in radiation exposure of combined chest and abdomen CT scans between scans with prior 0°- and 180°-localisers in conjunction with patient positioning. In this IRB-approved retrospective study, patients who had two routine thoracoabdominal CT scans on the same CT scanner, one with a prior 0°- and one with a prior 180°-localiser, were included. To evaluate the radiation exposure of the thoracoabdominal CT examination regarding the tube position during the localiser, volumetric computed tomography dose index (CTDIvol), size-specific dose estimate (SSDE), patient diameter and positioning within the iso-centre for three positions (heart, abdomen, femur level) were compared with regard to the tube position during the prior localiser. CT examinations of 114 patients were included. Despite similar patient weight and diameter between the two examinations, SSDE and CTDIvol was significantly larger (up to 73%) with 180°-localisers. Patient offset from the iso-centre ranged between −9 mm at the centre slice (abdomen level) to −43 mm at the most caudal slice at the pelvis (femur level), causing a significant magnification (p < 0.001) on 180°-localisers with a subsequent increase of the apparent attenuation. The results of this study emphasise the use of 0°-localisers in thoracoabdominal CTs, since 180°-localisers caused patient magnification with subsequent increase in radiation exposure. The advantage of 180°-localisers, namely reducing the dose in thyroid and breast, is eliminated if the dose of the CT scan increases significantly in the abdomen and pelvis.

139 “Never Event, Never Again” - a Closed Loop Audit on the Documentation of Nasogastric Tube Position Following X-Ray Confirmation

Abstract Aim Nasogastric feeding is common among ENT patients with dysphagia. CXRs are performed to confirm tube position before feeding. However, communication failure from poor documentation potentially leads to feeding through a misplaced tube into the lungs which is a "Never Event". This audit aims to reduce risk of patient harm by encouraging the use of nasogastric tube documentation sticker on clinical notes in Royal Victoria Hospital ENT ward. Method An initial study was conducted in June 2022 evaluating the quality of documentation of NGT position following CXR. Subsequently, several interventions were implemented including teaching doctors on utilising the documentation sticker that comes with each NGT pack, placing posters on the ward and reminding the nursing staff to check the documentation before starting feed. Further re-audit was carried out in August 2022 post-intervention. Results 58 CXRs were performed. Use of the documentation sticker rose from 42.1% to 85%. This led to verification of patient identity increasing from 39.5% to 100% and confirmation that the x-ray was most recent for the patient from 44.7% to 100%. 85% of the x-rays had time and date verified compared to 34.2% previously. Documentation of the position of NGT and instructions for feeding improved from 63.1% to 75% and 65.8% to 75% respectively. Record of the staff who confirmed tube position increased from 60.5% to 75%. Conclusions This audit demonstrated an increased use of the documentation sticker resulting in improvements in confirmation and documentation of NGT position. These positive changes reduce risks of significant patient harm thereby improving patient safety.

Iatrogenic Esophageal Perforation in Premature Infants: A Multicenter Retrospective Study from Poland.

Greater awareness of possible iatrogenic esophageal perforation (EP) is needed. Though rare, EP is a legitimate health risk as it may lead to long-term morbidities. This study presents and discusses iatrogenic EP in a subset of preterm infants. Using radiographic images, we study and describe the consequences of the orogastric/nasogastric tube position (in radiographic images). We analyze the possible influence of histological chorioamnionitis on the development of esophageal perforation. This retrospective study examines the hospital records of 1149 preterm infants, 2009-2016, with very low birth weight (VLBW) and iatrogenic EP, comparing mortalities and morbidities between the two groups of preterm infants who had birth weights (BWs) of less than 750 g and were less than 27 weeks gestation age at birth: one group with iatrogenic esophageal perforation (EP group) and one group without perforation (non-EP group-the control group). Histopathological chorioamnionitis of the placenta showed no statistically significant differences between the groups. The only statistically significant difference was in the air leaks (p = 0.01). Three types of nasogastric tube (NGT) X-ray location were identified, depending on the place of the perforation: (1) high position below the carina mimicking esophageal atresia; (2) low, intra-abdominal; (3) NGT right pleura-directed. We also highlight the particular symptoms that may be indicative of EP due to a displacement of the nasogastric tube.

Tube-first Technique as a Conduit for Easy and Fast Nasal Fiberoptic Intubation

Background: Classical nasal fiberoptic bronchoscope intubation may be a challenging and lengthy procedure with a 1-10% failure rate. Objectives: This study aimed to compare among patients with difficult airway intubation undergoing general anesthesia, the safety, and efficacy of Tube-First (TF) nasal fiberoptic bronchoscope intubation against the Classic (CL) procedure. Methods: This single-blinded, parallel-group, randomized trial enrolled 40 adult patients with known difficult airways and scheduled for surgery under general anesthesia. The patients were randomly allocated into two (n=20 each) patient groups. In the CL group, the endotracheal tube and fiberoptic bronchoscope were inserted together through the nostril; in the TF group, the endotracheal tube insertion preceded the fiberoptic bronchoscope. In both groups, the bronchoscope was used to visualize the vocal cords and removed after ensuring the endotracheal tube position. The primary (efficacy) outcomes were the time elapsing from the bronchoscope insertion and visualizing the vocal cords (T1) and the time elapsing from the bronchoscope advancing initiation to its removal (T2). The secondary (safety) outcomes included oxygen saturation and hemodynamic parameters during the procedure. Results: The TF group showed a significant T1 and T2 mean reduction compared to those of the CL group (37.15 ± 3.87 and 64.25 ± 8.28 vs. 55.05±4.52 and 88.25±5.49 seconds, respectively; p &lt; 0.0001). The oxygen saturation was comparable in both groups with no desaturation (SpO2 &lt; 90%) cases. The heart rate and mean arterial blood pressure changes were significantly lower in the TF group compared to the CL group. Conclusion: Among patients with difficult airway intubation undergoing general anesthesia, we found the Tube-First intubation approach was quicker and safer compared to the classical intubation technique.

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...

Addressing desaturation in a tracheal stenosis patient using the transnasal humidified rapid-insufflation ventilatory exchange technique during tracheostomy: A case report.

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is used in tracheostomy but not in cases of airway obstruction. This case report explores the use of THRIVE for managing airway obstruction during tracheostomy in patients with subglottic and tracheal stenosis, thereby addressing the current knowledge gap and exploring its potential for airway management. A 63-year-old female with subglottic and tracheal stenoses underwent tracheostomy. Multiple attempts to establish a patent airway were unsuccessful, and oxygen saturation dropped to 56%. Endotracheal tube was directed toward the tracheal wall, causing airway obstruction. THRIVE was administered to the patient. Subsequently, the tube position was adjusted to enhance ventilation. The patient's oxygen saturation increased to 99%. The postoperative complications, including subcutaneous emphysema, pneumothorax, pneumomediastinum and pneumopericardium, resolved. The patient was discharged on postoperative day 9. THRIVE could be considered a temporary measure to enhance oxygenation before initiating a definitive treatment strategy.

Evidence based – Enteral feeding algorithm for Neurosurgery ICU/Ward

Enteral feeding is a procedure that is in practice internationally by nurses. Providing enteral feeding to the patients is an art and science of nursing that follows careful steps and principles. Nurses role is not only confined to administering enteral feed but also of educating, giving instructions to the family members, directing caregivers and significant others regarding initiating and maintaining enteral feeding, so that continuity of nutritional care is maintained even in the home setting. Once the patient is admitted in neurosurgical ICU, hemodynamic stability of the patient is utmost important, as hemodynamic instability of the patient may preclude the safe initiation of EN in the critical care patients. Initial stabilization is the key for patient survival followed by maintenance therapy like drugs, mobilization, position, continuous monitoring and nutrition. For determining the need of enteral feeding especially for neurosurgical and neurological patients three things should be given utmost importance i.e. Swallowing deficit, Unconsciousness (Level of consciousness) and Nutritional requirement. Can be easily remembered as pneumonic SUN.Confirming tube position is one of the critical step in effective enteral feeding practice in spite of that it has given least importance. It is recommended to confirm the tube position immediately after ryles’ tube insertion through radiologic methods which may be not feasible sometimes, therefore bedside methods can also be adopted Auscultation methods and Aspiration method are the most widely used method among all the bed side methods for confirming tube placement. Gastric residual volume is the amount aspirated from the stomach following administration of the enteral feed. An aspirate among of less than 500ml in 4-6 hours or less than 50% of last enteral feed is safe and indicates that GIT is functioning. Most patients nicely tolerate enteral feeding via gastric tube while few patients has delayed gastric emptying and high GRVs as a result of sedation, pain medications, hypothermia, decreased movement and the effect of being critically ill. Intolerance of enteral feeding is defined as more than 500ml or more than 50% of last enteral feeding. Though enteral feeding is the most popular procedure for ICU Nursing officer, but it is the most crucial in terms of deciding patient outcome. Effective enteral feeding requires through knowledge of initiation and maintenance of enteral feeding. Thus, this article propose simple algorithm to follow. Effectively delivering nutrition to the patient requires the help of dietitian and physician/surgeon to deal with its challenges that comes along with this golden feeding technique.

Preclinical trial of the effectiveness of a safety nasogastric tube to detect the tube position based on tidal volume and pepsin assay results in the gastrointestinal tract of Macaca fascicularis

BackgroundTube misplacement into the tracheobronchial tract is associated with pneumothorax in 0.5% of cases. NGT verification only detects the position of the tube at the end of the procedure. Therefore, a safe nasogastric tube (SNGT) was created to detect the NGT position in real time in a simple and inexpensive way. This study aimed to prove the effectiveness of the SNGT prototype in Macaca fascicularis.ResultAn SNGT producing 50% of the TV had 100% sensitivity and specificity in detecting the position of the tube at 100% of the TV, with a sensitivity of 100% and a specificity of 87.5%. There was a significant difference between the movement of the SNGT 50% TV and SNGT 100% TV airbags (p ≤ 0.05). However, there was no significant difference between the accuracy of placement of the 50% TV SNGT, 100% TV SNGT, and conventional NGT (p > 0.05). The pepsin enzyme had better sensitivity (100%) than pH paper (91.66%) in detecting the end-of-procedure tube position. This research has the potential to advance into human clinical trials.ConclusionSNGTs are highly effective in detecting the NGT position inside the respiratory and digestive tracts to prevent misplacement.

Analysis of Line and Tube Detection Performance of a Chest X-ray Deep Learning Model to Evaluate Hidden Stratification.

This retrospective case-control study evaluated the diagnostic performance of a commercially available chest radiography deep convolutional neural network (DCNN) in identifying the presence and position of central venous catheters, enteric tubes, and endotracheal tubes, in addition to a subgroup analysis of different types of lines/tubes. A held-out test dataset of 2568 studies was sourced from community radiology clinics and hospitals in Australia and the USA, and was then ground-truth labelled for the presence, position, and type of line or tube from the consensus of a thoracic specialist radiologist and an intensive care clinician. DCNN model performance for identifying and assessing the positioning of central venous catheters, enteric tubes, and endotracheal tubes over the entire dataset, as well as within each subgroup, was evaluated. The area under the receiver operating characteristic curve (AUC) was assessed. The DCNN algorithm displayed high performance in detecting the presence of lines and tubes in the test dataset with AUCs > 0.99, and good position classification performance over a subpopulation of ground truth positive cases with AUCs of 0.86-0.91. The subgroup analysis showed that model performance was robust across the various subtypes of lines or tubes, although position classification performance of peripherally inserted central catheters was relatively lower. Our findings indicated that the DCNN algorithm performed well in the detection and position classification of lines and tubes, supporting its use as an assistant for clinicians. Further work is required to evaluate performance in rarer scenarios, as well as in less common subgroups.