Application and Reliability Evaluation of Sternal Notch Sagittal Ultrasound Imaging for Endotracheal Tube Positioning in Neonates Under General Anesthesia: A Prospective Study Comparing Electronic Bronchoscopy.

Abstract

Objective: To evaluate the accuracy and reliability of sternal notch sagittal ultrasound imaging for neonatal endotracheal tube positioning by comparing the ultrasound-measured distance from the endotracheal tube tip to the right pulmonary artery with the electronic bronchoscopy-measured distance from the endotracheal tube tip to the carina.

Design: A prospective, single-center, observational study using a self-controlled design.

Setting: Department of Anesthesiology and Perioperative Medicine at Anhui Provincial Children's Hospital, Hefei, China.

Participants: Neonates undergoing endotracheal intubation under general anesthesia for both elective and urgent surgeries were included, with all intubations performed in the operating room.

Interventions: Neonates were evaluated for endotracheal tube position using both electronic bronchoscopy and ultrasound in the median sagittal plane at the sternal notch.

Measurements and main results: The distance from the endotracheal tube tip to the right pulmonary artery was measured using ultrasound imaging. The distance from the endotracheal tube tip to the carina was measured using electronic bronchoscopy. A high linear correlation was found between the two methods (r = 0.899, p < 0.001). The internal consistency of the three ultrasound measurements was high (Cronbach alpha = 0.985, ICC = 0.985). The precision of ultrasound measurements varied with endotracheal tube size, showing improved consistency with larger tube diameters. The mean absolute deviation (MAD) was 0.18 mm for the 2.5-mm ETT, 0.14 mm for the 3.0-mm ETT, and 0.12 mm for the 3.5-mm ETT, with corresponding coefficient of variation values of 5.60%, 4.50%, and 4.20%, respectively. No adverse events were observed during the ultrasound examination, whereas the incidence of hypoxemia during the electronic bronchoscopy examination was 18.4% (p < 0.001). In terms of operation time, the electronic bronchoscopy examination took (15.43 ± 4.34) seconds, while the ultrasound examination took (10.25 ± 4.27) seconds, with a significant difference between the two methods (p < 0.001).

Conclusion: Sternal notch sagittal ultrasound imaging shows highly consistent measurement results with electronic bronchoscopy for assessing the position of the endotracheal tube in neonates. Additionally, sternal notch sagittal ultrasound is safer and non-invasive, making it a viable alternative method for endotracheal tube positioning in neonates under general anesthesia, with significant clinical application value.