Role of Point of Care Ultrasound in Confirmation of Endotracheal Tube Placement in Children

Background: In the emergency department (ED), During airway management, tracheal intubation (TI) is a routine procedure in neonatal and pediatric critical care units, as well as the delivery room. The location of the endotracheal tube (ETT) should be confirmed as soon as possible since tube malposition is linked to severe complications such as aspiration, air leak syndromes, and oesophageal intubation. In perioperative, emergency, and critical care settings, ultrasound (US) gives point-of-care dynamic images of the airway.

Objective: The goal of this study is to evaluate the results of utilizing Trans-tracheal POCUS to confirm ETT implantation with other confirmatory procedures including colorimetric capnography and direct viewing.

Methods: The study was done at Al-Azhar & Tanta University Emergency Hospital and was a prospective observational study. To locate the tube, we employed tracheal sonography and an ETCO2 analyzer for capnography. We evaluated the amount of time required and the accuracy of the findings.

Results: There were a total of 40 children that required emergency endotracheal intubation. Endotracheal ETT was found in 37 (92.5%) of the patients, while esophageal ETT was seen in three (7.5%) patients. The capnography was the standard for detecting the ETT placement correctly. In 97 percent of patients, ultrasound was able to identify all esophageal intubation and confirm the insertion of an endotracheal tube (ETT) with a sensitivity of 100 percent and a specificity of 97.5 percent. The clinical assessment had misunderstood 16.2 percent of tracheal intubations and 2 out of 3 esophageal intubations.

Conclusion: POCUS is considered an accurate method in endotracheal tube insertion confirmation, resulting in safe, fast, and reliable airway management approaches.