Role of Ultrasonography in the Assessment of Correct Endotracheal Tube Placement in Neonates. A Prospective Single Center Study

Background: Endotracheal intubation remains a complex procedure in neonatal care as a malposition may lead to pulmonary complications. To confirm correct endotracheal tube (ETT) position, chest X-Ray (CX) is the reference investigation. However it is often delayed and exposes to ionizing radiations. Bedside ultrasonography (US) is a faster non-invasive technique which might supply CX.

Objective: To compare US and CX in order to confirm an endotracheal intubation and evaluate the appropriate ETT position.

Methods: All neonates admitted in our level III neonatal ward and intubated were included. Immediately after intubation, the radiology unit was called for a CX as well as the neonatologist to perform a bedside tracheal US which consisted in two views:

- a coronal view with direct visualization of the trachea to confirm the tracheal intubation

- a parasternal view to determine the distance between the tip of the tube and the aortic arch. A distance between 0.5 and 1 centimeter was considered as optimal.

On X-ray, ETT was in good position if visualized in relation to the body of the first thoracic vertebra.

Number of bradycardia and desaturations were recorded. Sensitivity, specificity, positive and negative predictive value of US to determine the same position of ETT as CX were calculated.

Results: Twenty five infants were included with a mean corrected gestational age of 32.3 weeks +/- 6.2 and mean birth weight of 1796g +/- 676. Endotracheal intubation was confirmed for all the patients by CX and US. The positive predictive value to confirm the intratracheal position of the tube was 100%. Sensitivity of US to detect the same ETT position as CX was 77%, specificity 29%. No adverse effects were recorded during the US.

Conclusion: Tracheal US, performed by neonatologists, is a fast investigation to confirm the tracheal intubation and appears feasible to evaluate ETT position.