Verification of Appropriate Insertion Depth of Endotracheal Tube Placement

Study Overview
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Brief Summary
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The investigators are trying to evaluate the efficacy of ultrasonographic determination of depth of endotracheal tube placement in infants and young children by using the pleural sliding sign.

Detailed Description
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It is difficult to determine the adequate depth of endotracheal tube placement in infants and young children. It is usually determined by an equation according to the patient's age (12 + age/2, cm) or auscultation method. The auscultation method is to intentionally place the tip of the endotracheal tube into the right main stem bronchus and then withdraw it until breath sounds are equal. The tube is fixed 1 or 2 cm proximal to the point where breath sounds become equal. However, in small children or infant, as the breadth sound in unilateral lung transmits the contralateral lung field and is often difficult to listen in a noisy operation room, it is often difficult to determine the depth by auscultation method. Pleural sliding sign, or sliding lung sign is a ultrasonographic finding that the visceral pleura moves against the parietal pleura. It is used to identify whether the lung is ventilated by ultrasound. The investigators are trying to use this pleural sliding sign to determine the depth of endotracheal tube, and compare this method with auscultation method.

Official Title
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Verification of Appropriate Insertion Depth of Endotracheal Tube Placement in Infants and Young Children by Ultrasonography

Conditions
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Endotracheal Intubation, Infants or Young Children

Intervention / Treatment
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* Other: determination by auscultation
* Other: determination by ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Infants or young children (less than body weight of 20 kg) undergoing elective surgery (general surgery, urology, plastic surgery, cardiac surgery) under general anesthesia with endotracheal intubation Exclusion Criteria: Patients with pneumothorax, pleural effusion, atelectasis, pneumonia hemodynamic unstable patients (inotropics use) History of difficult intubation Combined upper airway anomaly

Ages Eligible for Study
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Minimum Age: 1 Month
Maximum Age: 10 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Auscultation group<br>The depth of endotracheal tube placement is determined by auscultation. | Other: determination by auscultation<br>* determination of depth of endotracheal tube placement by auscultation<br>* Other names: auscultation;|
| Ultrasonography group<br>The depth of placement of endotracheal tube placement is determined by ultrasonographic finding of pleural sliding sign. | Other: determination by ultrasound<br>* determination of depth of endotracheal tube placement by ultrasound<br>* Other names: H-Universal Stand (sonosite, Bothell, WA, USA);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| the incidence of inadequate depth of endotracheal tube placement by flexible brochoscopy after intubation | the incidence of inadequate depth of endotracheal tube placement by flexible bronchoscopy 3 minute after intubation | 3 minutes after intubation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| incidence of repositioning of endotracheal tube placement | incidence of repositioning of endotracheal tube placement (when it is found that the depth of endotracheal tube placement was inadequate determined by saturation fall or airway pressure monitoring) | 10 min after anesthetic induction | 
| time to verification of appropriate insertion depth of endotracheal tube placement | time to verification of appropriate insertion depth of endotracheal tube placement by a independent observer | 30 minutes after the end of surgery | 
| blood pressure | systolic, diastolic, mean blood pressure before attempt of endotracheal intubation (5 min), during determining the depth of endotracheal tube placement (10 min), after determining the depth of endotracheal tube placement (20 min) | 5, 10, 20 min after anesthetic induction | 
| heart rate | heart rate before attempt of endotracheal intubation (5 min), during determining the depth of endotracheal tube placement (10 min), after determining the depth of endotracheal tube placement (20 min) | 5, 10, 20 min after anesthetic induction | 
| pulse oximetry | pulse oximetry before attempt of endotracheal intubation (5 min), during determining the depth of endotracheal tube placement (10 min), after determining the depth of endotracheal tube placement (20 min) | 5, 10, 20 min after anesthetic induction | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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depth of endotracheal tube placement, endotracheal intubation, endobronchial intubation