Intubation Confirmation

Neonatal endotracheal intubation is indicated for respiratory failure when mask ventilation is ineffective or prolonged, for the delivery of surfactant, during chest compressions, and in specific clinical circumstances such as airway abnormalities or congenital diaphragmatic hernia. Although endotracheal intubation is a commonly performed procedure in the neonatal intensive care unit, rates of correct endotracheal tube placement are suboptimal and accidental esophageal intubation is common, especially among trainees. Ensuring that the endotracheal tube (ETT) is within the trachea is important because incorrect placement is associated with hypoxemia, atelectasis, tracheal injury, intraventricular hemorrhage, and death. In this chapter we discuss methods of confirming ETT placement within the trachea, including clinical assessment, colorimetric and end-tidal carbon dioxide monitoring, respiratory function monitoring, point-of-care ultrasound, and chest radiograph.