Tracheal Ultrasound for Confirmation of ETT Placement in NICU

Ain Shams University

Status: Completed

Conditions: Endotracheal Tube; Preterm Neonates; Mechanical Ventilation

Treatments: Diagnostic Test: Chest x-ray; Diagnostic Test: tracheal ultrasound ( expert radiologist); Diagnostic Test: tracheal ultrasound by trainee neonatologist

Study type: Interventional

Funder types: Other

Identifiers

NCT07073105

Tracheal Ultrasound NICU

Details and patient eligibility

About

Improper placement of the endotracheal tube during intubation can lead to dangerous complications. It has been reported that chest radiography is the gold standard method for validation of endotracheal tube (ET) position .

This study will compare the effectiveness of endotracheal tube position obtained by ultrasonography vs that obtained by chest X-ray with two operators an expert and a trainee in preterm neonates.

This study will work to the extent that the trainee has the ability to do sonar for premature babies with the same efficiency as an ultrasound specialist.

Full description

neonate in the neonatal intensive care unit (NICU) are intubated for different reasons and most of these patients undergo chest X-rays (CXRs) several times during their ICU admission to confirm endotracheal tube (ETT) placement, monitor severity of cardiopulmonary illness, and detect complications of other indwelling devices Although the amount of radiation exposure is minimal with CXRs, exposure to multiple CXRs in NICU patients, especially in preterm, results in accumulated radiation burden over time. This can lead to tissue damage and is associated with an increased risk of malignancy Tracheal ultrasonography is technique for confirmation of proper endotracheal intubation. Potential advantages include detection of both main stem and esophageal intubation and less time to image availability than CXR and less radiation Point of care ultrasound (POCUS) of the anterior neck is increasingly used by emergency physicians and anesthesiologists to detect endotracheal and esophageal intubation. It is more accurate and faster than physical examination and capnography, with adult meta-analyses reporting that it has sensitivities of 93-98%, specificities of 97-98% We will explore effectiveness and reproducibility of tracheal ultrasonography done by in hospital neonatologist trainee in the technique vs the expert radiologist in determination of ET position.

Enrollment: 85 patients

Sex: All

Ages: 1 hour to 30 days old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Less than 35weeks gestational age
• Invasive mechanical ventilation via ETT.

Exclusion criteria

• Upper air way anomalies.
• eligible patients whose care team deemed enrollment will disrupt patient care.

Trial design

Primary purpose: Diagnostic

Allocation: Non-Randomized

Interventional model: Crossover Assignment

Masking: Quadruple Blind

---

85 participants in 3 patient groups

confirmation of ETT by CXR

Active Comparator group

Description:

confirmation of ETT site by CXR the gold standard

Treatment:

Diagnostic Test: Chest x-ray

ETT site confirmation by trainee tracheal ultrasound

Experimental group

Description:

confirmation of ETT site was done by tracheal ultrasound performed by a trainee neonatologist after receiving training for the procedure

Treatment:

Diagnostic Test: tracheal ultrasound by trainee neonatologist

ETT site confirmation by expert tracheal ultrasound

Experimental group

Description:

confirmation of ETT tube site by expert radiologist performing tracheal ultrasound

Treatment:

Diagnostic Test: tracheal ultrasound ( expert radiologist)