Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.
Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan.
Pediatr Pulmonol. 2022 Jul;57(7):1744-1750. doi: 10.1002/ppul.25955. Epub 2022 May 17.
Point-of-care ultrasound (POCUS) is a valuable tool to determine endotracheal tube (ETT) placement; however, few studies have compared it with standard confirmation methods. We evaluated the diagnostic accuracy of POCUS and time-to-interpretation for correct identification of tracheal versus esophageal intubations compared to a composite of standard-of-care methods in neonates.
A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi, Pakistan. All required intubations were performed as per NICU guidelines. The clinical team simultaneously determined the ETT placement using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by POCUS. In addition, the clinical team was blinded to the POCUS images. Timings were recorded for each method by independent study staff.
A total of 348 neonates were enrolled in the study. More than half (58%) of intubations were in an emergency scenario. POCUS user interpretation showed 100% sensitivity and 94% specificity using an expert as the reference standard. We found a 99.4% agreement (Kappa: 0.96; p < 0.001). Diagnostic accuracy of POCUS compared with at least two standard-of-care methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9% agreement (Kappa:0.93; p < 0.001). The median time required for POCUS interpretation was 3.0 (interquartile range [IQR] 3.0-4.0) seconds for tracheal intubation. The time recorded for auscultation and capnography was 6.0 (IQR 5.0-7.0) and 3.0 (IQR 3.0-4.0), respectively.
POCUS is a rapid and reliable method of identifying ETT placement in neonates. Early and correct identification of airway management is critical to save lives and prevent mortality and morbidity.
床边超声（POCUS）是确定气管内导管（ETT）位置的有价值的工具；然而，很少有研究将其与标准确认方法进行比较。我们评估了 POCUS 的诊断准确性以及与标准护理方法相结合的时间，以正确识别气管与食管插管。
在巴基斯坦卡拉奇 Aga Khan 大学医院的新生儿重症监护病房（NICU）进行了一项横断面研究。所有需要的插管均按照 NICU 指南进行。临床团队同时使用标准护理方法（听诊、比色 capnography 和胸部 X 射线）通过 POCUS 确定 ETT 位置。此外，临床团队对 POCUS 图像是盲目的。独立的研究人员记录了每种方法的时间。
共有 348 名新生儿入组研究。超过一半（58%）的插管是在紧急情况下进行的。POCUS 用户解释使用专家作为参考标准，显示出 100%的敏感性和 94%的特异性。我们发现 99.4%的一致性（Kappa：0.96；p<0.001）。POCUS 与至少两种标准护理方法的比较显示出 99.7%的敏感性、91%的特异性和 98.9%的一致性（Kappa：0.93；p<0.001）。POCUS 解释的中位数时间为 3.0（四分位距 [IQR] 3.0-4.0）秒，用于气管插管。听诊和 capnography 的记录时间分别为 6.0（IQR 5.0-7.0）和 3.0（IQR 3.0-4.0）。
POCUS 是一种快速可靠的识别新生儿 ETT 位置的方法。早期和正确识别气道管理对挽救生命和预防死亡率和发病率至关重要。
