Abstract

Objective: To compare the accuracy of ultrasound (US) in assessing cuffed endotracheal tube (ETT) position using the suprasternal visualization approach versus chest radiography for intubated Pediatric Intensive Care Unit (PICU) patients.
Methods: A prospective study was conducted between October 2014 and March 2016 on sixty-six intubated patients less than 15 years of age who met predetermined inclusion criteria. Suprasternal tracheal ultrasound was done to visualize the ETT cuff filled with saline before obtaining the routine chest radiography, the gold standard used to determine ETT position and depth. The results of two methods were compared.
Results: US examination to detect the proper position of ETT as compared to chest radiography revealed a sensitivity of 91.67% (95% CI, 80.02% to 97.68%), specificity of 83.33 % (95% CI, 58.58% to 96.42%), positive predictive value of 93.62% (95% CI, 82.46% to 98.66%), negative predictive value of 78.95 % (95% CI, 54.43% to 93.95%), positive likelihood ratio of 5.50 (95% CI 1.95 to 15.51), and Negative Likelihood Ratio of 0.10 (95% CI 0.04 to 0.26).
Conclusion: Ultrasonography was found to be a more feasible, safer, and relatively quicker alternative method to determine the proper position of ETT in the trachea of PICU patients when using salinefilled ETT cuff with high sensitivity and specificity. Larger controlled studies are needed to support generalizability.