Can bedside ultrasound make pediatric intubation safer?
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Abstract
Introduction: Rapid and accurate confirmation of endotracheal tube positioning and caliber is critical in pediatric practice. Traditional methods, such as radiography and capnography, have limitations related to time, radiation exposure, and the inability to assess depth or selectivity.
Objective: To map and synthesize the evidence on the use of ultrasonography (US) to confirm the positioning, depth, and caliber of the endotracheal tube in pediatric populations.
Method: Scoping review conducted according to the PRISMA-ScR guidelines. The PubMed, Embase, and Cochrane Library databases were searched in September 2025, with no language restriction. Clinical studies comparing US with radiography, capnography, bronchoscopy, or anatomical formulas were included. Those with samples smaller than ten participants, exclusively adult populations, or simulations without clinical data were excluded. Two independent reviewers screened and extracted the data. The findings were narratively synthesized in five domains: tracheal versus esophageal distinction, depth and selectivity, caliber estimation, time to confirmation, and reproducibility.
Results: Were included 23 studies published between 2010 and 2025, covering emergency, operating room, and pediatric intensive care settings. Ultrasonography generally showed sensitivity ≥ 90% and confirmation times of less than one minute.
Conclusion: Bedside ultrasound is an effective, rapid, and reproducible method for confirming the positioning and estimating the caliber of the endotracheal tube in pediatrics. Large-scale implementation requires standardization of protocols and structured training.
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