title: Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children.
abstract: OBJECTIVE
  We evaluated the accuracy of tracheal ultrasonography of a saline-inflated endotracheal tube (ETT) cuff for confirming correct ETT insertion depth.
  
  
  METHODS
  We performed a prospective feasibility study of children undergoing endotracheal intubation for surgery. Tracheal ultrasonography at the suprasternal notch was performed during transient endobronchial intubation and inflation of the cuff with saline, and with the ETT at a correct endotracheal position. Ultrasound videos were recorded at both positions, which were confirmed by fiberoptic bronchoscopy. These videos were shown to two independent blinded reviewers, who determined the presence or absence of a saline-inflated cuff. The primary outcome was accuracy of tracheal ultrasonography for appropriate ETT insertion depth.
  
  
  RESULTS
  Forty-two patients were enrolled. For correct endotracheal versus endobronchial positioning, pooled results from the reviewers revealed a sensitivity of 98.8% (95% CI=90-100%), a specificity of 96.4% (95% CI=87-100%), a PPV of 96.5% (95% CI=87-100%), a NPV of 98.8% (95% CI=89-100%), a positive likelihood ratio of 32 (95% CI=6-185), and a negative likelihood ratio of 0.015 (95% CI=0.004-0.2). Agreement between reviewers was high (kappa co-efficient=0.93; 95% CI=0.86 to 1). The mean duration of the ultrasound exam was 4.0s (range 1.0-15.0s).
  
  
  CONCLUSIONS
  Sonographic visualization of a saline-inflated ETT cuff at the suprasternal notch is an accurate and rapid method for confirming correct ETT insertion depth in children.
authors.affiliation: Department of Emergency Medicine, Division of Emergency Ultrasound, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, United States. Electronic address: oliver.tessaro@gmail.com.
authors.forename: Mark O
authors.initials: MO
authors.lastname: Tessaro
authors.affiliation: Department of Anesthesiology, Division of Emergency Ultrasound, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, United States.
authors.forename: Evan P
authors.initials: EP
authors.lastname: Salant
authors.affiliation: Department of Emergency Medicine, Division of Emergency Ultrasound, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, United States.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Arroyo
authors.affiliation: Department of Emergency Medicine, Division of Emergency Ultrasound, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, United States.
authors.forename: Lawrence E
authors.initials: LE
authors.lastname: Haines
authors.affiliation: Department of Emergency Medicine, Division of Emergency Ultrasound, Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, United States.
authors.forename: Eitan
authors.initials: E
authors.lastname: Dickman
mesh_terms: D000293:Adolescent; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000295:instrumentation*; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014132:Trachea / Q000000981:diagnostic imaging*; D014463:Ultrasonography
keywords: Diagnostic accuracy; Endobronchial intubation; Endotracheal tube; Intubation; Pediatrics; Ultrasound