Diagnostic value of pleural ultrasound to refine endotracheal tube placement in pediatric intensive care unit |
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| Affiliation: | 1. Pediatric Intensive Care Unit, CHU Necker-Enfants Malades, Paris, France;2. Pediatric Intensive Care Unit, hôpital Femme-Mère-Enfant, hospices civils de Lyon, Bron, France;3. Paris Fire Brigade Medical Emergency Department, Paris, France;4. Emergency department, Hôpital d''instruction des armées Laveran, Marseille, France;5. Pharmacology and Drug Evaluation in Children and Pregnant Women EA7323, Paris Descartes University, Sorbonne Paris Cité, Paris, France;1. Department of Child and Adolescent Psychiatry, Ankara University School of Medicine, Ankara, Turkey;2. Department of Pediatric Endocrinology, Dr. Sami Ulus Maternity and Children’s Health and Diseases Training and Research Hospital, Ankara, Turkey;1. Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon;2. INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie, Beirut, Lebanon;3. Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon;4. Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon;5. University of Nicosia Medical School, Nicosia, Cyprus;6. Faculty of Pharmacy, Lebanese University, Beirut, Lebanon;1. ERRSPP PACA, Timone Children''s Hospital, AP-HM, 264 rue Saint-Pierre, 13385 Marseille, France;2. ERRSPP La BRISE, 2 avenue Foch, 29609 Brest, France;3. ERRSPP Poitou-Charente, 2 rue de la Milétrie 86021 Poitiers, France;4. ERRSPP Nord Pas-de-Calais, Hôpital Albert Calmette, 59037 Lille, France;5. ERRSPP IHOP, 1 place Joseph Renaut, 69008 Lyon, France;6. ERRSPP Alsace CHU Hautepierre, Avenue Molière, 67098, Strasbourg, France;7. Enfant-do, Children''s hospital, (CHU), TSA 70034, 31059, Toulouse, France;8. Aix Marseille Univ, INSERM, INRAe, C2VN, Marseille, France;9. Department of Pediatric and Congenital Cardiology, Timone Enfant, AP‐HM, 264 rue Saint-Pierre, 13385 Marseille, France;1. Neonatal Unit, Health Sciences University, Kayseri City Hospital, Kayseri, Turkey;2. Department of Pediatrics, Health Sciences University, Kayseri City Hospital, Kayseri, Turkey;3. Department of Pediatric Nephrology, Health Sciences University, Kayseri City Hospital, Kayseri, Turkey;4. Department of Biochemistry, Health Sciences University, Kayseri City Hospital, Kayseri, Turkey;1. Dokuz Eylul University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Izmir, Turkey;2. University of Health Sciences, Dr. Behçet Uz Children''s Research and Training Hospital, Department of Pediatric Metabolism and Nutrition, Izmir, Turkey;3. Kocaeli University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Kocaeli, Turkey;4. Ministry of Health Ankara City Hospital, Department of Pediatric Metabolism and Nutrition, Ankara, Turkey;5. Kirikkale University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Kirikkale, Turkey;6. Ankara University Faculty of Medicine, Department of Pediatric Metabolism and Nutrition, Ankara, Turkey;7. Izmir Biomedicine and Genome Center, Izmir, Turkey |
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| Abstract: | Aim: To assess the diagnostic performance of a simplified lung point-of-care ultrasound (POCUS) to confirm the correct positioning of an endotracheal tube (ETT) in a pediatric intensive care unit (PICU) used to chest radiography (CXR), and to compare the time to obtain the ETT position between POCUS and CXR.Methods: We conducted a single-center prospective study in critically ill children requiring urgent endotracheal intubation. Esophageal tube malposition was first avoided using auscultation and end-tidal CO2. The ETT position was assessed with CXR and lung POCUS using the lung sliding sign on a pleural window. All of the investigators had to read guidelines and received 1-h training on the technical aspects of lung sliding. The primary objective was the accuracy of POCUS in confirming correct nonselective endotracheal intubation as compared with CXR.Results: A total of 71 patients were included from December 2016 to November 2018. CXR identified proper nonselective ETT placement in 43 of 71 (61%) patients, while the rate for selective intubation was 39%. The sensitivity and specificity of POCUS as compared with CXR were 77% and 68%, respectively. Median time to POCUS was significantly shorter than CXR (2 min to perform POCUS, 10 min to obtain radiographs, p<10−4).Conclusion: Pleural ultrasound, although faster than CXR, appears to be inadequate for identifying selective ETT after urgent intubation in a PICU less accustomed to this kind of ultrasound. In this heterogeneous and fragile population, timely POCUS may remain useful at the bedside as compared with auscultation, aiming at guiding optimal ETT placement and reducing respiratory complications, provided by trained physicians. |
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