Feasibility of three window point of care ultrasound in endotracheal tube positioning in the level III pediatric intensive care unit

Background: Proper placement of an endotracheal tube (ETT) is an important and very crucial step in airway management. Unrecognized esophageal intubation leads to catastrophic consequences. The standard elements of confirmation have significant limitations. There is no universally accepted gold standard. Recent literature has shown that point of care ultrasound (POCUS) may be helpful in confirming the correct ETT placement and positioning. Methods: We enrolled a prospective, convenience sample from all intubated patients in our pediatric ICU. As part of standard care unit protocol all patients had X-ray to confirm ETT position. Airway ultrasonography was performed immediately after intubation once ETT is secured and patient is connected to ventilator. Patient stability was insured before performing USG. The position of ETT will be confirmed by five-point ultrasonography window one at trachea, bilateral lung sliding and bilateral diaphragmatic movements. Tracheal ultrasonography will be perform using a SonoSite M-turbo linear and curvilinear probe (13-6 and 2-5 MHz). Results: The paediatric patients enrolled in the study were 40 in number. Most of the paediatric population i.e. 47.50% were in between 1-5 years of age The three‑window POCUS method correctly identified the ETT to be either in the trachea or oesophageal in all 40 instances, (Correct or incorrect or bronchial) sensitivity of 100.0% (95% confidence interval [CI] 88.3-100.0%) when compared to X-ray chest. There were no adverse events during ultrasound. The mean time required for three-window POCUS was 69.9±27.01 seconds as compared to X-ray 3337.5±1374.24 seconds which was statistically highly significant (p<0.0000001). Conclusions: POCUS is a very good bedside tool for detection and monitoring of ETT position in children in emergency setups. POCUS has very good sensitivity in detecting ETT position when compared to CXR. The time consumed to carry out POCUS is statistically significantly less than CXR and hence an effective lifesaving tool.