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Original research
Ultrasound assessment of endotracheal tube depth in neonates: a prospective feasibility study
  1. Orly Levkovitz1,
  2. Dana Schujovitzky2,
  3. Rodica Stackievicz3,
  4. Pierre Fayoux4,
  5. Iris Morag5,6,
  6. Ita Litmanovitz1,6,
  7. Shmuel Arnon1,6,
  8. Sofia Bauer1
  1. 1 Department of Neonatology, Meir Medical Center, Kfar Saba, Israel
  2. 2 Pediatrics, Meir Medical Center, Kfar Saba, Israel
  3. 3 Department of Radiology, Meir Medical Center, Kfar Saba, Israel
  4. 4 Department of Pediatric Otolaryngology-Head Neck Surgery, Université de Lille, Lille, France
  5. 5 Department of Neonatology, Shamir Medical Center Assaf Harofeh, Tzrifin, Israel
  6. 6 Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  1. Correspondence to Dr Orly Levkovitz, Department of Neonatology, Meir Medical Center, Kfar Saba 4428163, Israel; orly.levko{at}gmail.com

Abstract

Objective To examine the reliability of a novel ultrasound (US) method for assessment of endotracheal tube (ETT) position in neonates.

Design Prospective, observational, single-centre, feasibility study.

Setting Level III neonatal intensive care unit.

Patients Term and preterm neonates requiring endotracheal intubation.

Intervention 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.

Main outcome measures 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.

Results 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.

Conclusion 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.

  • Intensive Care Units, Neonatal
  • Neonatology
  • Respiratory Medicine

Data availability statement

Data are available upon reasonable request. CXR and US study images, infants' demographic details and US study details.

https://doi.org/10.1136/archdischild-2023-325855

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    Data availability statement

    Data are available upon reasonable request. CXR and US study images, infants' demographic details and US study details.

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    Footnotes

    • Contributors OL conceptualised and designed the study, performed the ultrasound studies, collected and curated the data, interpreted the analysed data, drafted the initial manuscript, prepared the visuals, reviewed and revised the manuscript, and serves as the guarantor of this study. DS carried out the statistical analyses and interpretation, drafted the initial manuscript, and reviewed and revised the manuscript. RS interpreted the data from X-ray studies and reviewed and revised the manuscript. PF collected and curated the data of the fetal and neonatal autopsies and reviewed and revised the manuscript. IM designed the study methodology and critically reviewed the manuscript for important intellectual content. IL conceptualised and designed the study and critically reviewed and revised the manuscript for important intellectual content. SA drafted the initial manuscript and critically reviewed and revised the manuscript for important intellectual content. SB coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • 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.