Pediatric Lung Sonography

Ever been in the middle of a pediatric resuscitation and wanted to know if the endotracheal tube was in the mainstem bronchus or the trachea or the esophagus? Or if the barotrauma of positive pressure had caused a pneumothorax? There's a lot out there on diaphragm excursion vs. lung sliding vs. visualization of the endotracheal tube at the neck and it's worth checking out though there is still a need for additional research in this potentially high-yield application (see references). Video below is from a 3 day old infant with poor breath sounds after pre-hospital intubation. Notice that a linear transducer shows you more than 5 interspaces and is a great way to get a global view of the hemithorax in a neonate. In this case there are A-lines (A vs B vs C vs E vs W vs Z coming in a future post) with no visible pleural sliding on the right side of the screen (towards the patient's feet), and normal sliding on the left side of the screen (towards the patient's head) with B-lines and a small pleural effusion present (likely a result of barotrauma with subsequent atelectasis of the right lung and reactive effusion vs. small hemothorax).

Thanks to Jen Chao for setting up the ultrasound course in El Salvador this past spring where this clip was obtained.



References

Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics. 2009 Jun;123(6):e1039-44. Epub 2009 May 4.

Blaivas M, Tsung JW. Point-of-care sonographic detection of left endobronchial main stem intubation and obstruction versus endotracheal intubation. J Ultrasound Med. 2008 May;27(5):785-9.

Galicinao J, Bush AJ, Godambe SA. Use of bedside ultrasonography for endotracheal tube placement in pediatric patients: a feasibility study. Pediatrics. 2007 Dec;120(6):1297-303.

Hsieh KS, Lee CL, Lin CC, Huang TC, Weng KP, Lu WH. Secondary confirmation of endotracheal tube position by ultrasound image. Crit Care Med. 2004 Sep;32(9 Suppl):S374-7.