Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
Pediatrics, Meir Medical Center, Kfar Saba, Israel.
Arch Dis Child Fetal Neonatal Ed. 2023 Dec 15;109(1):94-99. doi: 10.1136/archdischild-2023-325855.
To examine the reliability of a novel ultrasound (US) method for assessment of endotracheal tube (ETT) position in neonates.
Prospective, observational, single-centre, feasibility study.
Level III neonatal intensive care unit.
Term and preterm neonates requiring endotracheal intubation.
US measurement of the ETT tip to right pulmonary artery (RPA) distance was used to determine ETT position according to one-fourth to three-fourths estimated tracheal length for weight. US demonstration of pleural sliding and diaphragmatic movement was also assessed. Chest radiography (CXR) was performed following each intubation.
Agreement between US assessment of ETT tip position and CXR served as the gold standard. Sensitivity, specificity, positive and negative predictive values for each US method and correlation between ETT tip to RPA distance on US, and ETT tip to carina distance on CXR were assessed.
Forty-two US studies were performed on 33 intubated neonates. US evaluation of ETT-RPA distance identified 100% of ETTs positioned correctly: 77% deep and 80% high, demonstrating strong agreement with CXR (kappa=0.822). Sensitivity was 78%, specificity 100%, positive predictive value 100% and negative predictive value 86%. US ETT-RPA distance strongly correlated with CXR ETT-carina distance (r=0.826). No significant agreement was found between CXR and US assessment of pleural sliding and diaphragmatic movement. No adverse events were encountered during US scans.
US evaluation of ETT-RPA distance demonstrated excellent accuracy for determining ETT position in neonates compared with CXR. More research is needed to support its feasibility in clinical settings.
探讨一种评估新生儿气管内导管（ETT）位置的新型超声（US）方法的可靠性。
前瞻性、观察性、单中心可行性研究。
三级新生儿重症监护病房。
需要气管内插管的足月和早产儿。
使用 US 测量 ETT 尖端至右肺动脉（RPA）的距离，根据体重估计的气管长度的四分之一到四分之三来确定 ETT 位置。还评估了 US 显示的胸膜滑动和膈肌运动。每次插管后均行胸部 X 线摄影（CXR）。
US 评估的 ETT 尖端位置与 CXR 的一致性作为金标准。评估每种 US 方法的敏感性、特异性、阳性和阴性预测值，以及 US 上 ETT 尖端至 RPA 距离与 CXR 上 ETT 尖端至隆突距离之间的相关性。
对 33 例插管的新生儿进行了 42 次 US 研究。US 评估 ETT-RPA 距离可正确识别 100%的 ETT 位置：77%过深和 80%过高，与 CXR 具有很强的一致性（kappa=0.822）。敏感性为 78%，特异性为 100%，阳性预测值为 100%，阴性预测值为 86%。US ETT-RPA 距离与 CXR ETT-隆突距离具有很强的相关性（r=0.826）。未发现 CXR 与 US 评估胸膜滑动和膈肌运动之间存在显著一致性。US 扫描过程中未发生不良事件。
与 CXR 相比，US 评估 ETT-RPA 距离可准确确定新生儿 ETT 位置，具有较高的准确性。需要更多的研究来支持其在临床环境中的可行性。
