Handheld Ultrasound Confirmation of Pediatric Endotracheal Intubation in a Resource-Limited Country

OBJECTIVES: Chest radiograph (CXR) and colorimetric capnography for confirmation of endotracheal tube (ETT) placement may be costly and inaccessible in resource-limited countries. Point-of-care ultrasound (POCUS) is considered a low-cost, fast alternative. We sought to study the accuracy of bedside POCUS as compared with CXR, using a pocket-sized handheld device, for confirmation of ETT placement in the neonatal ICU and PICU. DESIGN: Prospective, observational study. SETTING: PICU and neonatal ICU in a tertiary care center in Nepal between October 1, 2023, and April 30, 2024. PATIENTS: Newborns to 14-year-old children. INTERVENTIONS: POCUS using a handheld device at the bedside. MEASUREMENTS AND MAIN RESULTS: POCUS was performed on 59 intubated children; 37 (62%) were males. Median age was 3 hours (interquartile range [IQR], 1-5 hr) in newborns (n = 27) and 24 months (IQR, 12-84 mo) in children (n = 32). POCUS demonstrated tracheal-confirmed ETT placement in 53 children (89.8%), suspected endobronchial in four, and indeterminate in two. CXR agreed with all 53 POCUS tracheal-confirmed intubations. There were three additional tracheal-confirmed cases on CXR and three endobronchial intubations. Sensitivity and specificity of POCUS for detection of ETT placement in the trachea, compared with CXR, were 94.6% (95% CI, 85.1-98.9%) and 100% (95% CI, 29.2-100%), respectively. Based on this, accuracy was calculated at 94.9%. CONCLUSIONS: Our study demonstrated good accuracy of POCUS using a handheld device to confirm ETT placement in neonates and children. It could be a reliable and effective method in a resource-limited country like Nepal.