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Utility of upper airway ultrasound for confirmation of endotracheal tube placement in the pediatric intensive care unit setting

Introduction: Confirmation of correct placement of the endotracheal tube (ETT) is as important as the procedure itself. Point-of-care ultrasound today is an indispensable modality in the intensive care unit (ICU) for augmenting the clinical assessment and guiding critical care procedures. In this study, we used point-of-care ultrasound to confirm ETT placement and compared the time taken to confirm the ETT placement by ultrasound and capnography (the gold standard of confirmatory ETT placement). Materials and Methods: The current study was a prospective study done in a tertiary care teaching hospital. Children between 1 month and 18 years of age were included in the study. Airway ultrasound was done during the intubation procedure by placing the probe transversely over the suprasternal notch, and the confirmation of placement of the tube in the trachea was done by visualizing the absence of double trachea sign, and later confirmed by capnography. The average time taken for confirmation by ultrasound and capnography was determined. Results: A total of 127 intubations were included. The average time taken for confirmation of placement of the ETT by airway ultrasound from the time of insertion of the laryngoscope blade was 26.8 ± 5.7 s, whereas by capnography, it was 35.5 ± 5.8 s. The study showed that airway ultrasound has a high sensitivity of 98.2% to detect tracheal intubation and specificity of 100% to detect esophageal intubation when compared to capnography. Conclusion: Airway ultrasound can serve as a novel method of confirming the ETT placement in the pediatric ICU with comparable sensitivity, specificity with the added advantage of a significantly faster time of confirmation with respect to capnography.