Assessment of Endotracheal Tube Placement in Newborn Infants: a Randomized Controlled Trial

Overview

Journal J Perinatol

Specialty Gynecology & Obstetrics

Date 2016 Jan 15

PMID 26765556

Citations 5

Authors

S van Os

P-Y Cheung

K Kushniruk

M OReilly

K Aziz

G M Schmolzer

Affiliations

Soon will be listed here.

Abstract

Objective: International resuscitation guidelines recommend clinical assessment and exhaled CO2 to confirm tube placement immediately after intubation. However, exhaled CO2 devices can display false negative results. In comparison, any respiratory function monitor can be used to measure and display gas flow in and out of an endotracheal tube. However, neither method has been examined in detail. We hypothesized that a flow sensor would improve the assessment of tracheal vs esophageal tube placement in neonates with a higher success rate and a shorter time to tube placement confirmation when compared with the use of a quantitative end-tidal CO2 (ETCO2) detector.

Study Design: Between December 2013 and September 2014, preterm and term infants requiring endotracheal intubation were eligible for inclusion and randomly allocated to either ETCO2 ('ETCO2 group') or flow sensor ('flow sensor group'). All infants were analyzed according to their group at randomization (that is, analysis was by intention-to-treat).

Result: During the study period, a total of 110 infants (n=55 for each group) were randomized. Successful endotracheal tube placements were correctly identified in 100% of cases by the flow sensor compared with 72% of cases with the ETCO2 detector within 10 inflations (P<0.05). The median (interquartile range) number of inflations needed to identify successful tube placement was significantly lower in the flow sensor group with 2 (1 to 3) inflations vs 8 (6 to 10) inflations with the ETCO2 detector (P<0.001).

Conclusion: A flow sensor would improve the assessment of successful endotracheal tube placement with a higher success rate and a shorter time compared with an ETCO2 detector.

Citing Articles

Realtime and noninvasive assessment of endotracheal tube displacement using near-infrared and visible cameras.

Lu T, Khampang P, Beydoun A, Berezovsky A, Rohde R, Hong W Biomed Opt Express. 2024; 15(11):6355-6369.

PMID: 39553880 PMC: 11563344. DOI: 10.1364/BOE.531815.

[Airway management in neonates and infants : Recommendations according to the ESAIC/BJA guidelines].

Kaufmann J, Huber D, Engelhardt T, Kleine-Brueggeney M, Kranke P, Riva T Anaesthesiologie. 2024; 73(7):473-481.

PMID: 38958671 PMC: 11222175. DOI: 10.1007/s00101-024-01424-2.

Airway management in neonates and infants: European Society of Anaesthesiology and Intensive Care and British Journal of Anaesthesia joint guidelines.

Disma N, Asai T, Cools E, Cronin A, Engelhardt T, Fiadjoe J Eur J Anaesthesiol. 2023; 41(1):3-23.

PMID: 38018248 PMC: 10720842. DOI: 10.1097/EJA.0000000000001928.

Determining Carina and Clavicular Distance-Dependent Positioning of Endotracheal Tube in Critically Ill Patients: An Artificial Intelligence-Based Approach.

Tsai L, Yuan K, Hou S, Wu W, Hsu C, Liu T Biology (Basel). 2022; 11(4).

PMID: 35453690 PMC: 9027916. DOI: 10.3390/biology11040490.

[Newborn resuscitation and support of transition of infants at birth].

Madar J, Roehr C, Ainsworth S, Ersda H, Morley C, Rudiger M Notf Rett Med. 2021; 24(4):603-649.

PMID: 34093078 PMC: 8170636. DOI: 10.1007/s10049-021-00894-w.

References

Etches P, Finer N . Endotracheal tube position in neonates. Am J Dis Child. 1992; 146(9):1013. DOI: 10.1001/archpedi.1992.02160210015002. View

Birmingham P, Cheney F, Ward R . Esophageal intubation: a review of detection techniques. Anesth Analg. 1986; 65(8):886-91. View

Nicoll J, OReilly M, LaBossiere J, Lee T, Cowan S, Bigam D . Effect of cardiac output changes on exhaled carbon dioxide in newborn piglets. Resuscitation. 2013; 84(10):1439-42. DOI: 10.1016/j.resuscitation.2013.05.004. View

Schmolzer G, Poulton D, Dawson J, Kamlin C, Morley C, Davis P . Assessment of flow waves and colorimetric CO2 detector for endotracheal tube placement during neonatal resuscitation. Resuscitation. 2010; 82(3):307-12. DOI: 10.1016/j.resuscitation.2010.11.008. View

Falck A, Escobedo M, Baillargeon J, Villard L, Gunkel J . Proficiency of pediatric residents in performing neonatal endotracheal intubation. Pediatrics. 2003; 112(6 Pt 1):1242-7. DOI: 10.1542/peds.112.6.1242. View

Tochen M . Orotracheal intubation in the newborn infant: a method for determining depth of tube insertion. J Pediatr. 1979; 95(6):1050-1. DOI: 10.1016/s0022-3476(79)80309-1. View

Klingenberg C, Wheeler K, Davis P, Morley C . A practical guide to neonatal volume guarantee ventilation. J Perinatol. 2011; 31(9):575-85. DOI: 10.1038/jp.2011.98. View

Aziz H, Martin J, Moore J . The pediatric disposable end-tidal carbon dioxide detector role in endotracheal intubation in newborns. J Perinatol. 2000; 19(2):110-3. DOI: 10.1038/sj.jp.7200136. View

Schmolzer G, Kamlin O, Dawson J, Te Pas A, Morley C, Davis P . Respiratory monitoring of neonatal resuscitation. Arch Dis Child Fetal Neonatal Ed. 2009; 95(4):F295-303. DOI: 10.1136/adc.2009.165878. View

10.

Schmolzer G, Hooper S, Crossley K, Allison B, Morley C, Davis P . Assessment of gas flow waves for endotracheal tube placement in an ovine model of neonatal resuscitation. Resuscitation. 2010; 81(6):737-41. DOI: 10.1016/j.resuscitation.2010.02.018. View

11.

Lane B, Finer N, Rich W . Duration of intubation attempts during neonatal resuscitation. J Pediatr. 2004; 145(1):67-70. DOI: 10.1016/j.jpeds.2004.03.003. View

12.

Blayney M, Costello S, Perlman M, Lui K, Frank J . A new system for location of endotracheal tube in preterm and term neonates. Pediatrics. 1991; 87(1):44-7. View

13.

Amarilyo G, Mimouni F, Oren A, Tsyrkin S, Mandel D . Orotracheal tube insertion in extremely low birth weight infants. J Pediatr. 2009; 154(5):764-5. DOI: 10.1016/j.jpeds.2008.11.057. View

14.

Schmolzer G, Bhatia R, Davis P, Tingay D . A comparison of different bedside techniques to determine endotracheal tube position in a neonatal piglet model. Pediatr Pulmonol. 2012; 48(2):138-45. DOI: 10.1002/ppul.22580. View

15.

ODonnell C, Davis P, Morley C . Use of supplementary equipment for resuscitation of newborn infants at tertiary perinatal centres in Australia and New Zealand. Acta Paediatr. 2005; 94(9):1261-5. DOI: 10.1111/j.1651-2227.2005.tb02086.x. View

16.

Kattwinkel J, Perlman J, Aziz K, Colby C, Fairchild K, Gallagher J . Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010; 122(18 Suppl 3):S909-19. DOI: 10.1161/CIRCULATIONAHA.110.971119. View

17.

Roehr C, Grobe S, Rudiger M, Hummler H, Nelle M, Proquitte H . Delivery room management of very low birth weight infants in Germany, Austria and Switzerland--a comparison of protocols. Eur J Med Res. 2010; 15(11):493-503. PMC: 3352658. DOI: 10.1186/2047-783x-15-11-493. View

18.

ODonnell C, Kamlin C, Davis P, Morley C . Endotracheal intubation attempts during neonatal resuscitation: success rates, duration, and adverse effects. Pediatrics. 2006; 117(1):e16-21. DOI: 10.1542/peds.2005-0901. View

19.

van Kaam A, Rimensberger P, Borensztajn D, De Jaegere A . Ventilation practices in the neonatal intensive care unit: a cross-sectional study. J Pediatr. 2010; 157(5):767-71.e1-3. DOI: 10.1016/j.jpeds.2010.05.043. View

20.

Kuhns L, POZNANSKI A . Endotracheal tube position in the infant. J Pediatr. 1971; 78(6):991-6. DOI: 10.1016/s0022-3476(71)80429-8. View