A ultrassonografia à beira do leito pode tornar a intubação pediátrica mais segura?
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Resumo
Introdução: A confirmação rápida e precisa do posicionamento e do calibre do tubo endotraqueal é fundamental na prática pediátrica. Métodos tradicionais, como radiografia e capnografia, apresentam limitações relacionadas ao tempo, à exposição à radiação e à incapacidade de avaliar profundidade ou seletividade.
Objetivo: Mapear e sintetizar as evidências sobre o uso da ultrassonografia (US) para confirmar o posicionamento, a profundidade e o calibre do tubo endotraqueal em populações pediátricas.
Método: Revisão de escopo conduzida conforme as diretrizes PRISMA-ScR. Foram pesquisadas as bases PubMed, Embase e Cochrane Library em setembro de 2025, sem restrição de idioma. Incluíram-se estudos clínicos que compararam US com radiografia, capnografia, broncoscopia ou fórmulas anatômicas. Excluíram-se aqueles com amostras menores que dez participantes, populações exclusivamente adultas ou simulações sem dados clínicos. Dois revisores independentes realizaram a triagem e a extração dos dados. Os achados foram sintetizados narrativamente em cinco domínios: distinção traqueal versus esofágica, profundidade e seletividade, estimativa de calibre, tempo de confirmação e reprodutibilidade.
Resultados: Foram incluídos 23 estudos publicados entre 2010 e 2025, abrangendo cenários de emergência, centro cirúrgico e terapia intensiva pediátrica. A ultrassonografia apresentou sensibilidade geralmente ≥ 90% e tempos de confirmação inferiores a um minuto.
Conclusão: A US à beira do leito é método eficaz, rápido e reprodutível para confirmar o posicionamento e estimar o calibre do tubo endotraqueal em pediatria. A implementação em larga escala requer padronização de protocolos e capacitação estruturada.
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