Abstract
Introduction: Point of care ultrasound (POCUS) is a useful tool
to determine endotracheal tube (ETT) placement; however, few studies
have compared it with standard methods of confirmation. We evaluated the
diagnostic accuracy of POCUS and time-to-interpretation for correct
identification of tracheal versus esophageal intubations compared to a
composite of standard-of-care methods in neonates.
Methods: A cross-sectional study was conducted in the Neonatal
Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi
Pakistan. All required intubations were performed as per NICU
guidelines. The ETT placement was determined using standard-of-care
methods (auscultation, colorimetric capnography, and chest X-ray) by a
clinical team, and simultaneously by POCUS. The clinical team was
blinded to the POCUS images. Timings were recorded for each method by
independent study staff.
Results: A total of 348 neonates were enrolled in the study.
More than half (58%) of intubations were in an emergency scenario.
Using an expert as the reference standard, POCUS user interpretation
showed 100% sensitivity and 94% specificity. We found a 99.4%
agreement (Kappa: 0.96; p<0.001) between the POCUS user and
expert.
Diagnostic accuracy of POCUS compared with at least two standard-of-care
methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9%
agreement (Kappa:0.93; p<0.001). The median time required for
POCUS interpretation was 3.0 (IQR 3.0 -4.0) seconds for tracheal
intubation. The time recorded for auscultation and capnography was 6.0
(IQR 5.0 -7.0) and 3.0 (IQR 3.0-4.0) respectively.
Conclusion: POCUS is a rapid and reliable method of identifying
ETT placement in neonates. Early and correct identification of airway
management is critical to save lives and prevent mortality and
morbidity.