Secondary confirmation of endotracheal tube position by ultrasound image.
OBJECTIVE
Secondary confirmation of endotracheal (ET) tube position by ultrasound image.


METHODS
Prospective, randomized study.


METHODS
A medical center-based tertiary pediatric intensive care unit.


METHODS
A total of 59 patients aged from newborn to 17 yrs old underwent ET tube insertion because of cardiopulmonary arrest or impending respiratory failure.


METHODS
Ultrasound imaging was performed immediately before and after the ET tube placement procedure. The most frequently used ultrasonic scanning window was the subxiphoid window at the mid-upper abdominal, just beneath the xiphoid process and the lower margin of liver. The sector angle was set as wide as possible (90 degrees) so that the bilateral diaphragm could be well scanned.


RESULTS
Using the ultrasound imaging method, we successfully identified all of two esophageal intubations and eight incidents of initial ET tube misplacement, which had been positioned down to the right main bronchus. Finally, we successfully identified all 59 of the correct placements of ET tubes in the trachea.


CONCLUSIONS
Ultrasound imaging of diaphragm motion is a useful, quick, noninvasive, portable, and direct anatomic method for assessment of ET tube position. We think it should be considered the method of choice for the secondary confirmation of the ET tube position.
Hsieh
Kai-Sheng
KS
Department of Pediatrics, Veterans General Hospital, Kaohsiung, Taiwan.
Lee
Cheng-Liang
CL
Lin
Chu-Chung
CC
Huang
Ta-Cheng
TC
Weng
Ken-Pen
KP
Lu
Wen-Hsien
WH
D000293:Adolescent; D022561:Advanced Cardiac Life Support; D002648:Child; D002675:Child, Preschool; D003964:Diaphragm / Q000000981:diagnostic imaging*; D005260:Female; D006323:Heart Arrest / Q000000981:diagnostic imaging / Q000628:therapy; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007442:Intubation, Intratracheal; D008297:Male; D012127:Respiratory Distress Syndrome, Newborn / Q000000981:diagnostic imaging / Q000628:therapy; D014463:Ultrasonography