Endotracheal tube position in pediatrics and neonates: comparison between flexible fiberoptic bronchoscopy and chest radiograph.

Background: Correct tracheal intubation in critically ill patient is very important in intensive care medicine. The purpose of this study is to evaluate the value and accuracy of the flexible fiberoptic bronchoscopy (FFB) in confirming the endotracheal tube (ETT) position and to compare with the chest radiograph method in intubated pediatric and neonate patients.

Methods: We prospectively used the FFB to evaluate the ETT position in the pediatric and neonate intensive care units (ICUs) from January 2000 to December 2000. The distance between the ETT tip and the trachea carina measured by FFB (TC-FFB) was recorded and compared with that by the chest radiograph (TC-CR). The consuming time needed for checking the ETT position was also compared between these two methods.

Results: There were 74 cases enrolled. There was a significant correlation between TC-FFB and TC-CR (r = 0.898, p = 0.000). It took less time to confirm the ETT position by using the FFB than by the post-intubation chest radiograph (0.3 +/- 0.1 min vs. 103.8 +/- 45.2 min, p < 0.05). No major complication was noted in performing the FFB measurement.

Conclusions: FFB is an accurate, convenient, timesaving and less traumatic technique in confirming the correct ETT position for the critical and emergent patients in the pediatric and neonate ICUs.