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In neonates who have been successfully intubated can ultrasound be used to accurately confirm endotracheal tube tip position?
  1. Shavindra Chellen1,
  2. Lawrence Miall2
  1. 1Neonatal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK
  2. 2Neonatal Medicine, Leeds General Infirmary, Leeds, UK
  1. Correspondence to Dr Shavindra Chellen, Neonatal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, West Yorkshire, UK; schellen{at}nhs.net

https://doi.org/10.1136/archdischild-2021-323146

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    Clinical scenario

    A neonate has just been intubated on the Neonatal Intensive Care Unit (NICU). The tube has been confirmed to be within the trachea through a combination of clinical and physiological signs. These include observing for symmetrical chest movement, listening for air leak at the mouth and auscultation of the chest and abdomen. Capnography is positive for end-tidal CO2, and the patient has shown a clinical improvement in colour, saturations and heart rate. A chest X-ray (CXR) is requested to confirm that the endotracheal tube (ET) tip sits below the upper border of the T1 vertebral body and above the lower border of the T2 vertebral body. While waiting for the radiographer to arrive you wonder whether the NICU’s ultrasound (US) machine could be used to confirm the ET tip position.

    Structured clinical question

    In neonates who have been successfully intubated, can ultrasound accurately confirm ET tip position when compared with CXR?

    Search

    Embase, Medline and the Cochrane library were searched. Original human studies were included. The following search terms were used: (newborn* OR neonat*) AND (intubation OR tracheal tube* OR endotracheal tube*) AND (ultrasound OR ultrasonograph* OR sonograph*) AND (confirm* OR placement OR position*). Additionally, Medical Subject Headings (MeSH) terms of ‘newborn/’; ‘intubation/’; ‘ultrasound/’ were used in Embase. MeSH terms of ‘infant, newborn/’ and ‘intubation/’ were used in Medline.

    Conference abstracts, posters and letters were excluded. Studies that had a mixed population of patients from Neonatal and Paediatric intensive care were excluded. The …

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    Footnotes

    • Twitter @DrMiall

    • Contributors The corresponding author, SC, was responsible for drafting this article. LM was responsible for revisions of this article. LM supervised the overall process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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