The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates.

OBJECTIVE: Given the distressingly high incidence of ETT malposition in the neonatal population, patients are exposed to ionizing radiation to confirm endotracheal tube (ETT) position. Our objective is to determine if ultrasound technique is concordant with X-ray in determining whether an ETT is deeply positioned or not.

STUDY DESIGN: Prospective observational clinical trial. After obtaining informed consent, patients with an ETT who required X-ray for clinical reasons underwent sonographic evaluation of the ETT by an ultrasound technologist or pediatric radiologist, usually within the hour.

RESULTS: A total of 56 image pairs were obtained from 29 patients. Ninety-eight percent of the ultrasound/X-ray image pairs were suitable for analysis. The concordance of ultrasound with X-ray to identify deeply and not deeply positioned ETTs was 95% (53/56). The sensitivity of ultrasound to detect deeply positioned ETTs on X-ray was 86% (6/7). The specificity of ultrasound to detect ETTs that were not deeply positioned on X-ray was 96% (47/49).

CONCLUSIONS: As the largest clinical trial of its kind to date, with the greatest number of ultrasound operators, we have further established US as a feasible imaging modality to determine whether an ETT is deeply positioned or not.