According to researchers, endotracheal tube positioning in pediatric emergency department patients can be determined with the help of diaphragmatic ultrasound. However, further evidence is needed before it is considered equivalent to chest radiography.
The general clinical implication of our study is for the feasibility of ultrasound as a diagnostic tool in pediatric emergency medicine, told lead investigator Dr. Benjamin T. Kerrey. There is a growing body of literature to support several different applications of ultrasound for our patients. Our study adds to that literature in a generally positive way.
Estimates of misplacement of endotracheal tubes in such patients observed by Dr. Kerrey and colleagues at Cincinnati Children’s Hospital Medical Center, ranged as high as 40%.
The team investigated 127 pediatric emergency department inpatients evaluated by both techniques, to compare ultrasound and chest radiography as placement aids. No esophageal intubations were found, but chest radiography showed that the tube was in the mainstem bronchus in 24 patients (19%).
Radiography and ultrasound agreed on placement in 94 tracheal placement patients and 12 mainstem bronchial placement patients, thus giving an overall agreement of 0.83. Sensitivity and specificity of ultrasound for tracheal placement was 0.91 and for mainstem intubation was 0.50 respectively.
The ultrasound approach took a median of 8 minutes less than radiography to provide the results which were also highly reproducible. A separate blinded sonographer came to the same conclusions as the original sonographer in 33 of 34 re-evaluated sonograms.
Although I cannot recommend diaphragmatic ultrasound be used ‘as is’ to confirm an intubation, concluded Dr. Kerrey, I feel our findings are promising and warrant further investigation.