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Improper placement of the endotracheal tube during intubation can lead to dangerous complications. It has been reported that chest radiography is the gold standard method for validation of endotracheal tube (ET) position .
This study will compare the effectiveness of endotracheal tube position obtained by ultrasonography vs that obtained by chest X-ray with two operators an expert and a trainee in preterm neonates.
This study will work to the extent that the trainee has the ability to do sonar for premature babies with the same efficiency as an ultrasound specialist.
neonate in the neonatal intensive care unit (NICU) are intubated for different reasons and most of these patients undergo chest X-rays (CXRs) several times during their ICU admission to confirm endotracheal tube (ETT) placement, monitor severity of cardiopulmonary illness, and detect complications of other indwelling devices Although the amount of radiation exposure is minimal with CXRs, exposure to multiple CXRs in NICU patients, especially in preterm, results in accumulated radiation burden over time. This can lead to tissue damage and is associated with an increased risk of malignancy Tracheal ultrasonography is technique for confirmation of proper endotracheal intubation. Potential advantages include detection of both main stem and esophageal intubation and less time to image availability than CXR and less radiation Point of care ultrasound (POCUS) of the anterior neck is increasingly used by emergency physicians and anesthesiologists to detect endotracheal and esophageal intubation. It is more accurate and faster than physical examination and capnography, with adult meta-analyses reporting that it has sensitivities of 93-98%, specificities of 97-98% We will explore effectiveness and reproducibility of tracheal ultrasonography done by in hospital neonatologist trainee in the technique vs the expert radiologist in determination of ET position.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| confirmation of ETT by CXR | Active Comparator | confirmation of ETT site by CXR the gold standard |
|
| ETT site confirmation by trainee tracheal ultrasound | Experimental | confirmation of ETT site was done by tracheal ultrasound performed by a trainee neonatologist after receiving training for the procedure |
|
| ETT site confirmation by expert tracheal ultrasound | Experimental | confirmation of ETT tube site by expert radiologist performing tracheal ultrasound |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| tracheal ultrasound ( expert radiologist) | Diagnostic Test | tracheal ultrasound, performed by expert radiologist, for preterm neonates for confirmation of ETT site |
|
| Measure | Description | Time Frame |
|---|---|---|
| time in minutes to receive tracheal ultrasound by trainee neonatologist results for ETT site | Time taken from giving order to perform the tracheal ultrasound by trainee neonatologist to receiving the results of the imaging | 24 hours |
| time in minutes to receive CXR results for ETT site | Time taken from giving order to perform chest x ray to receiving the results of the imaging | 24 hours |
| time in minutes to receive tracheal ultrasound by expert radiologist results for ETT site | Time taken from giving order to perform the tracheal ultrasound by expert radiologist to receiving the results of the imaging | 24 hours |
| reproducibility of results between CXR , expert and trainee tracheal ultrasound | Accuracy of the findings of the tracheal ultrasound by expert, trainee and chest x ray for the same patient | 24 hours |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| mariam ibrahim, MD, PHD | Ain Shams University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ain Shams University Hospitals | Cairo | Egypt |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41364152 | Derived | Ibrahim MJA, Elbarbary MNED, Yacoub GEE, Abdo MAM. Confirmation and reproducibility of endotracheal tube position by tracheal ultrasonography in preterms: expert versus trainee. Eur J Pediatr. 2025 Dec 9;185(1):2. doi: 10.1007/s00431-025-06626-3. |
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individual participant data can be shared after publication from the corresponding author upon reasonable request
after publication
from the coresponding author
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| ID | Term |
|---|---|
| D003952 | Diagnostic Imaging |
| ID | Term |
|---|---|
| D019937 | Diagnostic Techniques and Procedures |
| D003933 | Diagnosis |
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| tracheal ultrasound by trainee neonatologist | Diagnostic Test | tracheal ultrasound, performed by trainee neonatologist ( after receiving training for the procedure) , for preterm neonates for confirmation of ETT site |
|
| Chest x-ray | Diagnostic Test | chest xray done for confirmation of ETT site |
|