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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Endotracheal intubation &#40;EI&#41; is an essential technique in airway management&#46; However&#44; it can be associated to potentially serious complications&#44; such as unrecognised oesophageal intubation &#40;OI&#41; or one-lung intubation&#46; Consequently&#44; it is important to verify the correct placement and depth of insertion of the endotracheal tube &#40;ETT&#41; after each intubation&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Direct laryngoscopy allows the direct verification of the EI&#44; but it requires proficiency by the operator and the interruption of resuscitation manoeuvres in patients with cardiac arrest&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> There are alternative methods such as auscultation&#44; capnography&#44; observation of chest movements&#44; observation of condensation in the ETT&#44; and raising the heart rate in neonates&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Although none of the existing methods have been proven to be fully reliable&#44; capnography is the most widely used and recommended&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Chest radiography is routinely performed in most units to check the correct placement of the tip of the ETT after intubation&#46; There is still little experience in the use of ultrasound in paediatric intubation&#46; Studies in adults seem to suggest that ultrasonography is as reliable and fast as conventional methods and could be advantageous in specific situations&#44; such as cardiopulmonary arrest&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;8&#8211;10</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The purpose of our study was to assess the feasibility and efficacy of ultrasonography in EI compared with the most widely used methods&#44; such as capnography or chest radiography&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study design</span><p id="par0015" class="elsevierStylePara elsevierViewall">We conducted a diagnostic validation study between January 2011 and June 2013&#46; The study included patients admitted to the paediatric and neonatal intensive care units who required intubation at a time when the researcher in charge of performing the ultrasound tests was available&#46; None of the patients were undergoing cardiac arrest and all were haemodynamically stable&#46; The protocol of the study was approved by the clinical research ethics committee of the hospital&#44; and we obtained signed informed consent from the parents or legal guardians&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Ultrasound performance and interpretation</span><p id="par0020" class="elsevierStylePara elsevierViewall">Ultrasound was performed with a portable device &#40;Vivid i&#44; General Electrics&#44; Atlanta&#44; United States&#41; fitted with an 8<span class="elsevierStyleHsp" style=""></span>Hz microconvex array transducer and a 12<span class="elsevierStyleHsp" style=""></span>Hz linear array transducer&#44; recommended for their capacity to generate detailed images of superficial structures&#46; Because of its small size&#44; the microconvex transducer was used in infants younger than 1 year&#44; and the linear transducer was used in children older than 1 year&#46; The transducer was placed superior to the suprasternal notch with the neck slightly extended for the tracheal ultrasound &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; longitudinally along the mid-axillary line on either hemithorax for the chest ultrasound&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">When the ETT is inside the trachea&#44; the transverse ultrasound shows a double tract sign produced by the interface between the air and the ETT&#44; giving rise to a &#8220;comet tail&#8221; artefact &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The presence of this artefact has shown a sensitivity of 100&#37; in several studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In OI the comet tail is not seen&#44; and at times the ETT can be visualised in the oesophagus in a paratracheal position&#44; although this is not a constant finding&#46; In the longitudinal view&#44; EI generates an echogenic double tract sign along the trachea immediately posterior to the tracheal rings that is not seen in OI &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; If the ETT is in the extrathoracic trachea &#40;superior malposition&#41; the tip of the ETT is seen along with a posterior acoustic shadow that corresponds to the air in the trachea &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; The correct depth of insertion of the ETT is confirmed by 2-D mode chest ultrasound&#44; which allows the assessment of lung sliding&#44; understood as visualisation of the visceral pleura sliding against the parietal pleura in an expanded chest&#46; The presence of bilateral&#44; symmetrical sliding rules out one-lung intubation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> In M-mode&#44; normal lung sliding generates the so-called &#8220;seashore sign&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The absence of the sliding lung sign is not specific of one-lung intubation&#44; and it is important to be aware that it also appears in pneumothorax&#44; large atelectases&#44; and pulmonary consolidation with restricted movement on insufflation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study protocol was divided into 2 phases&#58; &#40;1&#41; intubation with simultaneous confirmation using capnography and tracheal ultrasound&#44; and &#40;2&#41; Determination of ETT placement with chest ultrasound and chest X-ray&#46; The attending physician performed the intubation&#46; A paediatrician with 5 years&#8217; experience in ultranonography performed all the ultrasounds&#44; and a second researcher timed how long it took to perform each technique&#46; The recorded times did not include the start-up time of the ultrasound machine nor the time spent in the set-up and calibration of the capnography device&#46; The time spent in the radiograph spanned from the time it was requested to the time it was read in the computer terminals of the unit&#46; The information obtained by ultrasound was not shared with the attending physician to avoid influencing his clinical perspective&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the chronological diagram of the study protocol&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Capnography identification of EI was defined as the presence of 3 or more consecutive waveforms with a clearly identifiable plateau during ventilation with a bag-valve mask&#46; Correct placement of the ETT was defined as radiography showing the distal end of the ETT at about 2<span class="elsevierStyleHsp" style=""></span>cm above the carina&#46; In radiography&#44; superior malposition was defined as position of the ETT above the sternoclavicular articulation&#44; and one-lung intubation as the ETT seen at the opening or inside the right mainstem bronchus&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We considered that EI was identified by ultrasound when one of the characteristic ultrasound signs mentioned above was found in one of the examined planes&#46; The insertion depth of the ETT was considered correct when the tip of the ETT was not seen in the extrathoracic trachea in the longitudinal view&#44; and when a bilateral sliding lung was clearly identified in chest ultrasound&#46; When the tip of the ETT was observed in the longitudinal ultrasound it was considered a sign of superior malposition&#44; and if unilateral lung sliding on the right was observed&#44; it was considered a sign of one-lung intubation&#46; The algorithm proposed for the use of ultrasound in EI is shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Quantitative data are expressed as median and range&#44; and qualitative data as relative frequencies &#40;n&#47;N&#41;&#46; We compared the frequency of EIs determined by capnography with the frequency determined by ultrasound&#44; and the number of correct placements determined by ultrasound with the number determined by radiography&#46; We also compared the time it took to perform the different procedures&#46; Comparisons were made for the results of the subsets of patients in the PICU and NICU&#46; We used nonparametric tests &#40;Wilcoxon matched pairs test&#44; and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for independent samples&#41; and the chi-squared test&#46; The statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The sample included 31 intubations in 26 patients&#46; Thirteen were neonates in the NICU with a median gestational age of 32 weeks &#40;range&#44; 24&#8211;40 weeks&#41; and a median weight of 1438<span class="elsevierStyleHsp" style=""></span>g &#40;range&#44; 530&#8211;3450<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; There were 13 children in the PICU with a median age of 4 years &#40;range&#44; 3 months&#8211;14 years&#41; and a median weight of 21<span class="elsevierStyleHsp" style=""></span>kg &#40;range&#44; 4&#8211;58<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> summarise the results of the capnography vs ultrasonography and the radiography vs ultrasonography comparisons&#46; We found no significant differences in the ability to detect EI between capnography and ultrasound in NICU or PICU patients&#59; however&#44; ultrasound was significantly slower&#44; a difference that was not observed in the PICU patient subset&#46; We found no significant differences between radiography and ultrasound either&#46; The ETT was not visualised by means of ultrasound in 2 neonates with positive capnography&#46; On the other hand&#44; ultrasound did not detect 2 malpositions &#40;ETT placed too high&#41; that were detected in the radiograph&#46; Using capnography as the standard criterion&#44; ultrasonography showed a sensitivity of 92&#37; and a specificity of 100&#37; in detecting the presence of the ETT in the trachea&#46; Ultrasonography also showed a sensitivity of 100&#37; and a specificity of 75&#37; compared to radiography in detecting the correct depth of insertion of the ETT&#46; Ultrasonography was significantly faster than radiography in every comparison&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Ultrasonography has been used in airway management to investigate anatomy&#44; estimate the size of the ETT&#44; verify ETT placement&#44; and detect one-lung intubation&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;15&#8211;20</span></a> We believe that one of the most interesting aspects of ultrasound is that&#44; besides visualisation of the ETT&#44; it allows evaluation of its insertion depth and ruling out incorrect placement&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of our study was to compare the usefulness of ultrasonography to identify EI with other&#44; more widely used methods&#44; such as capnography and chest radiography&#46; We found that ultrasonography is efficacious in the identification of EI&#44; with high sensitivity and specificity compared to capnography&#46; However&#44; it is a considerably slower method&#46; We must highlight that the difference in time was observed in the NICU group&#46; This is probably due to the small size of neck structures in neonates&#44; which makes it more difficult to implement the technique&#46; In older children&#44; ultrasonography was as quick as capnography&#46; Since it is safe and fast&#44; capnography is currently the most widely used method to confirm EI&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11</span></a> However&#44; it may not be reliable in patients with cardiopulmonary arrest due to an insufficient tidal volume&#46; In this context&#44; ultrasound can be advantageous in emergent intubations&#46; Studies with large samples conducted by Sim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and Chou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have demonstrated that ultrasound performed better than capnography in patients with cardiopulmonary arrest&#46; Furthermore&#44; we found that ultrasound is as fast as capnography in older children&#44; which suggests it may be useful under these circumstances&#44; in which reliability and speed are crucial&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Other situations in which ultrasound can offer advantages over capnography are low tidal volume&#44; for instance in premature neonates&#44; or the presence of severe bronchospasm&#46; In the absence of these special circumstances&#44; if capnography is available&#44; ultrasound should not be used or should be used only as an adjunct technique&#46; We also observed that performing this technique in neonates presented more difficulty&#44; which may be the reason why the ETT was not visualised in 2 neonates that had been intubated correctly &#40;false negatives&#41;&#46; Finally&#44; superior malposition of the ETT was not detected in 2 neonates&#46; These aspects need to be taken into account when considering the use of ultrasound in neonates&#44; especially if the operator is inexperienced&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ultrasound was as efficacious as chest radiography both in the PICU and the NICU&#44; with high sensibility and moderate specificity&#46; The false negatives in our study corresponded to nondetection of the superior malposition of the ETT in neonates using ultrasound&#46; This may have been due to the small size of the neck&#44; which makes it difficult to determine whether the tip of the ETT is or is not in the extrathoracic trachea&#46; Ultrasound clearly required less time than radiography&#46; This finding was also reported by Sim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in the adult population and by Kerrey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> and Galicinao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in children&#46; Another study on adults conducted by Pfeiffer et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a> showed that ultrasound is as quick as auscultation and outperforms capnography combined with auscultation in determining the placement of the ETT&#46; Another advantage of ultrasound compared to radiography is that in situations where the ETT may be displaced by patient handling&#44; ultrasound can be used to verify its placement as many times as needed without associated exposure to radiation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There is little experience in the use of ultrasound to confirm ETT placement in the paediatric age group&#46; Kerrey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> reported that ultrasound is equivalent to chest radiography in determining the position of the ETT within the airway&#46; It is worth noting that the ultrasound technicians in this study were inexperienced&#46; Previous research shows that ultrasound can be used reliably by prehospital care providers with little training&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a> Later&#44; a paediatric study by Galicinao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> showed a 100&#37; sensitivity and specificity of ultrasound when compared to clinical detection methods and chest radiography&#46; This study also compared ultrasound with capnography and concluded that ultrasound should be considered an adjunct method that offers some advantages in specific situations&#46; We believe that ultrasonography can be useful to verify ETT placement and rule out malposition in a timely manner after intubation&#44; avoiding routine performance of chest radiography&#44; especially in older children&#46; Our results suggest that in neonates&#44; if there are any signs of superior malposition &#40;such as excessive leaks from the ventilator&#41;&#44; ultrasound may not be sufficient&#44; and a radiograph needs to be performed&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The main strengths of our study are its prospective nature&#44; that a single operator performed all ultrasounds&#44; and that it is the first study simultaneously comparing ultrasonography with other standard methods&#44; like radiography and capnography&#44; in children and neonates&#46; The main limitation is the small number of patients included in the study&#44; as well as their heterogeneity&#46; Another limitation is that the study was performed in the controlled environment of the ICU&#44; where the number of oesophageal intubations or incorrectly placed ETTs tends to be low&#46; This may limit the generalisability of its results to other settings&#44; such as prehospital or emergency care&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Future research should assess the role of ultrasonography in airway management&#44; specifically in the context of cardiopulmonary arrest of haemodynamic instability&#46; Ideally&#44; it would entail multicentre studies in large-volume paediatric hospitals&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Ultrasound is as efficacious as capnography in verifying ETT placement&#44; although it may take more time&#44; especially in neonates&#46; Other disadvantages in neonates are that it may produce false negatives&#44; and that it is difficult to identify superior malposition&#46; Ultrasound is an efficacious and fast method for determining the depth of insertion of the ETT and ruling out one-lung intubation&#44; so it could contribute to reduce the routine use of radiography&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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          "titulo" => "Materials and methods"
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    "fechaRecibido" => "2013-11-19"
    "fechaAceptado" => "2014-01-10"
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            0 => "Bedside ultrasound"
            1 => "Tracheal intubation"
            2 => "Newborn"
            3 => "Children"
            4 => "Capnography"
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            0 => "Ecograf&#237;a"
            1 => "Intubaci&#243;n traqueal"
            2 => "Neonatos"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included&#46; Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously&#46; The endotracheal tube insertion depth was then checked by assessment of lung sliding by thoracic ultrasound&#46; Thereafter&#44; Chest X-ray was performed and interpreted as usual&#46; Time to perform each technique was recorded&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 31 intubations in 26 patients &#40;15 in PICU and 16 in NICU&#41;&#46; There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and X-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth&#44; respectively&#46; Sensibility and specificity of ultrasound compared to capnography were 92&#37; and 100&#37;&#44; and 100&#37; and 75&#37; compared to X-ray&#46; Ultrasound was significantly slower compared to capnography &#91;12 &#40;4&#8211;16&#41; vs 6 &#40;3&#8211;12&#41;<span class="elsevierStyleHsp" style=""></span>s&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93; and significantly quicker compared to X-ray &#91;0&#46;22 &#40;0&#46;17&#8211;0&#46;40&#41; vs&#46; 20 &#40;17&#8211;25&#41;<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ultrasound appears to be as effective as capnography&#44; although slower&#44; for identifying endotracheal intubation&#46; Ultrasound may be useful in clinical situations&#44; such as cardiopulmonary resuscitation where capnography is less reliable&#46; Ultrasound is as effective as&#44; and quicker than X-ray for assessment of endotracheal tube insertion depth&#44; and it may contribute to decrease the routine use of X-ray after tracheal intubation&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar la utilidad de la ecograf&#237;a frente a la capnograf&#237;a y la radiograf&#237;a en la intubaci&#243;n traqueal &#40;IT&#41; en ni&#241;os y neonatos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a pacientes hemodin&#225;micamente estables intubados en la UCIP y UCIN&#46; Se verific&#243; la posici&#243;n del tubo endotraqueal &#40;TET&#41; tras cada intubaci&#243;n mediante ecograf&#237;a traqueal y capnograf&#237;a&#46; Posteriormente&#44; se comprob&#243; la profundidad del TET por ecograf&#237;a mediante la visualizaci&#243;n de la punta del mismo y el deslizamiento pleural y&#44; posteriormente&#44; con radiograf&#237;a de t&#243;rax&#46; Se cronometraron los tiempos de realizaci&#243;n de las t&#233;cnicas&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 31 intubaciones en 26 pacientes &#40;15 en UCIP y 16 en UCIN&#41;&#46; No hubo diferencias significativas entre la ecograf&#237;a y la capnograf&#237;a ni entre la ecograf&#237;a y la radiograf&#237;a en la detecci&#243;n de la IT ni en la comprobaci&#243;n de la profundidad del TET&#46; La sensibilidad y la especificidad de la ecograf&#237;a comparada con la capnograf&#237;a y la radiograf&#237;a fueron del 92 y el 100&#37;&#44; y del 100 y el 75&#37;&#44; respectivamente&#46; La ecograf&#237;a fue significativamente m&#225;s lenta que la capnograf&#237;a &#40;12 &#91;4&#8211;16&#93; vs&#46; 6 &#91;3&#8211;12&#93; s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y m&#225;s r&#225;pida que la radiograf&#237;a &#40;0&#44;22 &#91;0&#44;17&#8211;0&#44;40&#93; vs&#46; 20 &#91;17&#8211;25&#93; min&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a parece tan efectiva como la capnograf&#237;a&#44; aunque m&#225;s lenta en la comprobaci&#243;n de la IT&#46; Podr&#237;a ser de utilidad en situaciones donde la capnograf&#237;a no sea fiable&#46; La ecograf&#237;a es tan efectiva y m&#225;s r&#225;pida que la radiograf&#237;a en la evaluaci&#243;n de la profundidad del TET&#44; por lo que podr&#237;a disminuir la utilizaci&#243;n rutinaria de la radiograf&#237;a&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">1st stage&#58; determination of intubation</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tracheal ultrasound&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Transverse plane<span class="elsevierStyleHsp" style=""></span>Longitudinal plane<span class="elsevierStyleHsp" style=""></span>Tip of the ETT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Set up&#8805;3 normal waveforms with plateaus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
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                  \t\t\t\t">Securing ETT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2nd stage&#58; determination of ETT insertion depth&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Capnography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tracheal intubation&#44; n&#47;N</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;520&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Time in seconds</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;12&#8211;116&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#8211;10&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;4&#8211;116&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Radiograph&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Correct ETT position&#44; n&#47;N</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCIN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;472&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;871&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Time in minutes</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21 &#40;0&#46;17&#8211;0&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;18&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;25 &#40;0&#46;18&#8211;0&#46;40&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;17&#8211;25&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22 &#40;0&#46;17&#8211;0&#46;40&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20 &#40;17&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Comparison of ultrasonography and radiography in confirmation of ETT position&#46;</p>"
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            3 => array:3 [
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                  "host" => array:1 [
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                        0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46;R&#46; De Caen"
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                            2 => "L&#46; Chameides"
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                  "host" => array:1 [
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                      "doi" => "10.1016/j.resuscitation.2010.08.028"
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                        "tituloSerie" => "Resuscitation"
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                        "volumen" => "81"
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                        "paginaFinal" => "e259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20956041"
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              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of three different methods to confirm tracheal tube placement in emergency intubation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46; Grmec"
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                    ]
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00134-002-1290-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Intensive Care Med"
                        "fecha" => "2002"
                        "volumen" => "28"
                        "paginaInicial" => "701"
                        "paginaFinal" => "704"
                        "link" => array:1 [
                          0 => array:2 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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Original article
Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation
Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal
P. Alonso Quintelaa,
Corresponding author
paulaalonsoquintela@gmail.com

Corresponding author.
, I. Oulego Errozb,d, M. Mora Matillaa, S. Rodríguez Blancoc,d, D. Mata Zubillagae, L. Regueras Santosd
a Servicio Pediatría, Complejo Asistencial Universitario de León, León, Spain
b Servicio de Cardiología, Complejo Asistencial Universitario de León, León, Spain
c Servicio de Neonatología, Complejo Asistencial Universitario de León, León, Spain
d Unidad de Cuidados Intensivos Pediátricos, Complejo Asistencial Universitario de León, León, Spain
e Centro de Salud Ponferrada IV, Complejo Asistencial Universitario de León, León, Spain
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giving rise to a &#8220;comet tail&#8221; artefact &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>A&#41;&#46; The presence of this artefact has shown a sensitivity of 100&#37; in several studies&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In OI the comet tail is not seen&#44; and at times the ETT can be visualised in the oesophagus in a paratracheal position&#44; although this is not a constant finding&#46; In the longitudinal view&#44; EI generates an echogenic double tract sign along the trachea immediately posterior to the tracheal rings that is not seen in OI &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>B&#41;&#46; If the ETT is in the extrathoracic trachea &#40;superior malposition&#41; the tip of the ETT is seen along with a posterior acoustic shadow that corresponds to the air in the trachea &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>C&#41;&#46; The correct depth of insertion of the ETT is confirmed by 2-D mode chest ultrasound&#44; which allows the assessment of lung sliding&#44; understood as visualisation of the visceral pleura sliding against the parietal pleura in an expanded chest&#46; The presence of bilateral&#44; symmetrical sliding rules out one-lung intubation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> In M-mode&#44; normal lung sliding generates the so-called &#8220;seashore sign&#8221; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; The absence of the sliding lung sign is not specific of one-lung intubation&#44; and it is important to be aware that it also appears in pneumothorax&#44; large atelectases&#44; and pulmonary consolidation with restricted movement on insufflation&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;14</span></a>&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Study protocol</span><p id="par0030" class="elsevierStylePara elsevierViewall">The study protocol was divided into 2 phases&#58; &#40;1&#41; intubation with simultaneous confirmation using capnography and tracheal ultrasound&#44; and &#40;2&#41; Determination of ETT placement with chest ultrasound and chest X-ray&#46; The attending physician performed the intubation&#46; A paediatrician with 5 years&#8217; experience in ultranonography performed all the ultrasounds&#44; and a second researcher timed how long it took to perform each technique&#46; The recorded times did not include the start-up time of the ultrasound machine nor the time spent in the set-up and calibration of the capnography device&#46; The time spent in the radiograph spanned from the time it was requested to the time it was read in the computer terminals of the unit&#46; The information obtained by ultrasound was not shared with the attending physician to avoid influencing his clinical perspective&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the chronological diagram of the study protocol&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Capnography identification of EI was defined as the presence of 3 or more consecutive waveforms with a clearly identifiable plateau during ventilation with a bag-valve mask&#46; Correct placement of the ETT was defined as radiography showing the distal end of the ETT at about 2<span class="elsevierStyleHsp" style=""></span>cm above the carina&#46; In radiography&#44; superior malposition was defined as position of the ETT above the sternoclavicular articulation&#44; and one-lung intubation as the ETT seen at the opening or inside the right mainstem bronchus&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">We considered that EI was identified by ultrasound when one of the characteristic ultrasound signs mentioned above was found in one of the examined planes&#46; The insertion depth of the ETT was considered correct when the tip of the ETT was not seen in the extrathoracic trachea in the longitudinal view&#44; and when a bilateral sliding lung was clearly identified in chest ultrasound&#46; When the tip of the ETT was observed in the longitudinal ultrasound it was considered a sign of superior malposition&#44; and if unilateral lung sliding on the right was observed&#44; it was considered a sign of one-lung intubation&#46; The algorithm proposed for the use of ultrasound in EI is shown in <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">Quantitative data are expressed as median and range&#44; and qualitative data as relative frequencies &#40;n&#47;N&#41;&#46; We compared the frequency of EIs determined by capnography with the frequency determined by ultrasound&#44; and the number of correct placements determined by ultrasound with the number determined by radiography&#46; We also compared the time it took to perform the different procedures&#46; Comparisons were made for the results of the subsets of patients in the PICU and NICU&#46; We used nonparametric tests &#40;Wilcoxon matched pairs test&#44; and Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for independent samples&#41; and the chi-squared test&#46; The statistical significance was set at <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;05&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">The sample included 31 intubations in 26 patients&#46; Thirteen were neonates in the NICU with a median gestational age of 32 weeks &#40;range&#44; 24&#8211;40 weeks&#41; and a median weight of 1438<span class="elsevierStyleHsp" style=""></span>g &#40;range&#44; 530&#8211;3450<span class="elsevierStyleHsp" style=""></span>g&#41;&#46; There were 13 children in the PICU with a median age of 4 years &#40;range&#44; 3 months&#8211;14 years&#41; and a median weight of 21<span class="elsevierStyleHsp" style=""></span>kg &#40;range&#44; 4&#8211;58<span class="elsevierStyleHsp" style=""></span>kg&#41;&#46; <a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a> summarise the results of the capnography vs ultrasonography and the radiography vs ultrasonography comparisons&#46; We found no significant differences in the ability to detect EI between capnography and ultrasound in NICU or PICU patients&#59; however&#44; ultrasound was significantly slower&#44; a difference that was not observed in the PICU patient subset&#46; We found no significant differences between radiography and ultrasound either&#46; The ETT was not visualised by means of ultrasound in 2 neonates with positive capnography&#46; On the other hand&#44; ultrasound did not detect 2 malpositions &#40;ETT placed too high&#41; that were detected in the radiograph&#46; Using capnography as the standard criterion&#44; ultrasonography showed a sensitivity of 92&#37; and a specificity of 100&#37; in detecting the presence of the ETT in the trachea&#46; Ultrasonography also showed a sensitivity of 100&#37; and a specificity of 75&#37; compared to radiography in detecting the correct depth of insertion of the ETT&#46; Ultrasonography was significantly faster than radiography in every comparison&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0060" class="elsevierStylePara elsevierViewall">Ultrasonography has been used in airway management to investigate anatomy&#44; estimate the size of the ETT&#44; verify ETT placement&#44; and detect one-lung intubation&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;15&#8211;20</span></a> We believe that one of the most interesting aspects of ultrasound is that&#44; besides visualisation of the ETT&#44; it allows evaluation of its insertion depth and ruling out incorrect placement&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The aim of our study was to compare the usefulness of ultrasonography to identify EI with other&#44; more widely used methods&#44; such as capnography and chest radiography&#46; We found that ultrasonography is efficacious in the identification of EI&#44; with high sensitivity and specificity compared to capnography&#46; However&#44; it is a considerably slower method&#46; We must highlight that the difference in time was observed in the NICU group&#46; This is probably due to the small size of neck structures in neonates&#44; which makes it more difficult to implement the technique&#46; In older children&#44; ultrasonography was as quick as capnography&#46; Since it is safe and fast&#44; capnography is currently the most widely used method to confirm EI&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11</span></a> However&#44; it may not be reliable in patients with cardiopulmonary arrest due to an insufficient tidal volume&#46; In this context&#44; ultrasound can be advantageous in emergent intubations&#46; Studies with large samples conducted by Sim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> and Chou et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> have demonstrated that ultrasound performed better than capnography in patients with cardiopulmonary arrest&#46; Furthermore&#44; we found that ultrasound is as fast as capnography in older children&#44; which suggests it may be useful under these circumstances&#44; in which reliability and speed are crucial&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Other situations in which ultrasound can offer advantages over capnography are low tidal volume&#44; for instance in premature neonates&#44; or the presence of severe bronchospasm&#46; In the absence of these special circumstances&#44; if capnography is available&#44; ultrasound should not be used or should be used only as an adjunct technique&#46; We also observed that performing this technique in neonates presented more difficulty&#44; which may be the reason why the ETT was not visualised in 2 neonates that had been intubated correctly &#40;false negatives&#41;&#46; Finally&#44; superior malposition of the ETT was not detected in 2 neonates&#46; These aspects need to be taken into account when considering the use of ultrasound in neonates&#44; especially if the operator is inexperienced&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Ultrasound was as efficacious as chest radiography both in the PICU and the NICU&#44; with high sensibility and moderate specificity&#46; The false negatives in our study corresponded to nondetection of the superior malposition of the ETT in neonates using ultrasound&#46; This may have been due to the small size of the neck&#44; which makes it difficult to determine whether the tip of the ETT is or is not in the extrathoracic trachea&#46; Ultrasound clearly required less time than radiography&#46; This finding was also reported by Sim et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> in the adult population and by Kerrey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> and Galicinao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> in children&#46; Another study on adults conducted by Pfeiffer et al&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a> showed that ultrasound is as quick as auscultation and outperforms capnography combined with auscultation in determining the placement of the ETT&#46; Another advantage of ultrasound compared to radiography is that in situations where the ETT may be displaced by patient handling&#44; ultrasound can be used to verify its placement as many times as needed without associated exposure to radiation&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">There is little experience in the use of ultrasound to confirm ETT placement in the paediatric age group&#46; Kerrey et al&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> reported that ultrasound is equivalent to chest radiography in determining the position of the ETT within the airway&#46; It is worth noting that the ultrasound technicians in this study were inexperienced&#46; Previous research shows that ultrasound can be used reliably by prehospital care providers with little training&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a> Later&#44; a paediatric study by Galicinao et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> showed a 100&#37; sensitivity and specificity of ultrasound when compared to clinical detection methods and chest radiography&#46; This study also compared ultrasound with capnography and concluded that ultrasound should be considered an adjunct method that offers some advantages in specific situations&#46; We believe that ultrasonography can be useful to verify ETT placement and rule out malposition in a timely manner after intubation&#44; avoiding routine performance of chest radiography&#44; especially in older children&#46; Our results suggest that in neonates&#44; if there are any signs of superior malposition &#40;such as excessive leaks from the ventilator&#41;&#44; ultrasound may not be sufficient&#44; and a radiograph needs to be performed&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The main strengths of our study are its prospective nature&#44; that a single operator performed all ultrasounds&#44; and that it is the first study simultaneously comparing ultrasonography with other standard methods&#44; like radiography and capnography&#44; in children and neonates&#46; The main limitation is the small number of patients included in the study&#44; as well as their heterogeneity&#46; Another limitation is that the study was performed in the controlled environment of the ICU&#44; where the number of oesophageal intubations or incorrectly placed ETTs tends to be low&#46; This may limit the generalisability of its results to other settings&#44; such as prehospital or emergency care&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Future research should assess the role of ultrasonography in airway management&#44; specifically in the context of cardiopulmonary arrest of haemodynamic instability&#46; Ideally&#44; it would entail multicentre studies in large-volume paediatric hospitals&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0095" class="elsevierStylePara elsevierViewall">Ultrasound is as efficacious as capnography in verifying ETT placement&#44; although it may take more time&#44; especially in neonates&#46; Other disadvantages in neonates are that it may produce false negatives&#44; and that it is difficult to identify superior malposition&#46; Ultrasound is an efficacious and fast method for determining the depth of insertion of the ETT and ruling out one-lung intubation&#44; so it could contribute to reduce the routine use of radiography&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            0 => "Bedside ultrasound"
            1 => "Tracheal intubation"
            2 => "Newborn"
            3 => "Children"
            4 => "Capnography"
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            0 => "Ecograf&#237;a"
            1 => "Intubaci&#243;n traqueal"
            2 => "Neonatos"
            3 => "Ni&#241;os"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0015">Materials and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included&#46; Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously&#46; The endotracheal tube insertion depth was then checked by assessment of lung sliding by thoracic ultrasound&#46; Thereafter&#44; Chest X-ray was performed and interpreted as usual&#46; Time to perform each technique was recorded&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 31 intubations in 26 patients &#40;15 in PICU and 16 in NICU&#41;&#46; There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and X-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth&#44; respectively&#46; Sensibility and specificity of ultrasound compared to capnography were 92&#37; and 100&#37;&#44; and 100&#37; and 75&#37; compared to X-ray&#46; Ultrasound was significantly slower compared to capnography &#91;12 &#40;4&#8211;16&#41; vs 6 &#40;3&#8211;12&#41;<span class="elsevierStyleHsp" style=""></span>s&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93; and significantly quicker compared to X-ray &#91;0&#46;22 &#40;0&#46;17&#8211;0&#46;40&#41; vs&#46; 20 &#40;17&#8211;25&#41;<span class="elsevierStyleHsp" style=""></span>min&#44; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#93;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Ultrasound appears to be as effective as capnography&#44; although slower&#44; for identifying endotracheal intubation&#46; Ultrasound may be useful in clinical situations&#44; such as cardiopulmonary resuscitation where capnography is less reliable&#46; Ultrasound is as effective as&#44; and quicker than X-ray for assessment of endotracheal tube insertion depth&#44; and it may contribute to decrease the routine use of X-ray after tracheal intubation&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evaluar la utilidad de la ecograf&#237;a frente a la capnograf&#237;a y la radiograf&#237;a en la intubaci&#243;n traqueal &#40;IT&#41; en ni&#241;os y neonatos&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a pacientes hemodin&#225;micamente estables intubados en la UCIP y UCIN&#46; Se verific&#243; la posici&#243;n del tubo endotraqueal &#40;TET&#41; tras cada intubaci&#243;n mediante ecograf&#237;a traqueal y capnograf&#237;a&#46; Posteriormente&#44; se comprob&#243; la profundidad del TET por ecograf&#237;a mediante la visualizaci&#243;n de la punta del mismo y el deslizamiento pleural y&#44; posteriormente&#44; con radiograf&#237;a de t&#243;rax&#46; Se cronometraron los tiempos de realizaci&#243;n de las t&#233;cnicas&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluy&#243; a 31 intubaciones en 26 pacientes &#40;15 en UCIP y 16 en UCIN&#41;&#46; No hubo diferencias significativas entre la ecograf&#237;a y la capnograf&#237;a ni entre la ecograf&#237;a y la radiograf&#237;a en la detecci&#243;n de la IT ni en la comprobaci&#243;n de la profundidad del TET&#46; La sensibilidad y la especificidad de la ecograf&#237;a comparada con la capnograf&#237;a y la radiograf&#237;a fueron del 92 y el 100&#37;&#44; y del 100 y el 75&#37;&#44; respectivamente&#46; La ecograf&#237;a fue significativamente m&#225;s lenta que la capnograf&#237;a &#40;12 &#91;4&#8211;16&#93; vs&#46; 6 &#91;3&#8211;12&#93; s&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y m&#225;s r&#225;pida que la radiograf&#237;a &#40;0&#44;22 &#91;0&#44;17&#8211;0&#44;40&#93; vs&#46; 20 &#91;17&#8211;25&#93; min&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La ecograf&#237;a parece tan efectiva como la capnograf&#237;a&#44; aunque m&#225;s lenta en la comprobaci&#243;n de la IT&#46; Podr&#237;a ser de utilidad en situaciones donde la capnograf&#237;a no sea fiable&#46; La ecograf&#237;a es tan efectiva y m&#225;s r&#225;pida que la radiograf&#237;a en la evaluaci&#243;n de la profundidad del TET&#44; por lo que podr&#237;a disminuir la utilizaci&#243;n rutinaria de la radiograf&#237;a&#46;</p>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Please cite this article as&#58; Alonso Quintela P&#44; Oulego Erroz I&#44; Mora Matilla M&#44; Rodr&#237;guez Blanco S&#44; Mata Zubillaga D&#44; Regueras Santos L&#46; Utilidad de la ecograf&#237;a comparada con la capnograf&#237;a y la radiograf&#237;a en la intubaci&#243;n traqueal&#46; An Pediatr &#40;Barc&#41;&#46; 2014&#59;81&#58;283&#8211;288&#46;</p>"
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          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Transverse plane&#58; hyperechogenic shadowing or &#8220;comet tail&#8221; sign &#40;C&#41; visible in ET&#46; &#40;B&#41; Longitudinal plane&#58; double track echogenic line corresponding to the ETT &#40;arrow&#41; posterior to tracheal rings&#46; &#40;C&#41; In cases of superior malposition&#44; a posterior acoustic shadow corresponding to the air in the trachea can be visualised &#40;arrow&#41;&#46; T&#58; thyroid&#59; Trach&#58; trachea&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Algorithm proposed for the use of ultrasound in ETT placement confirmation&#46; Tr&#58; transverse ultrasound scan&#46; L&#58; Longitudinal ultrasound scan&#46; ETT&#58; endotracheal tube&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:1 [
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">1st stage&#58; determination of intubation</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Tracheal ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Capnography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleHsp" style=""></span>Transverse plane<span class="elsevierStyleHsp" style=""></span>Longitudinal plane<span class="elsevierStyleHsp" style=""></span>Tip of the ETT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Set up&#8805;3 normal waveforms with plateaus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab581245.png"
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            1 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Securing ETT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2nd stage&#58; determination of ETT insertion depth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Chest radiography request</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Chest ultrasound</span><span class="elsevierStyleHsp" style=""></span>Sliding lung sign<span class="elsevierStyleHsp" style=""></span>Seashore sign&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Chest radiography interpretation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Chronology of the study protocol&#46;</p>"
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        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "tabla" => array:2 [
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              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Capnography&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Tracheal intubation&#44; n&#47;N</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;414&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">26&#47;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;520&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Time in seconds</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;4&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;3&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;184&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>NICU&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;12&#8211;116&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;4&#8211;10&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;4&#8211;116&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;3&#8211;12&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001 PICU ultrasound vs NICU ultrasound&#46;</p>"
            ]
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              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;005 PICU capnography vs NICU capnography&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Comparison of ultrasound and capnography in identification of tracheal intubation&#46;</p>"
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        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:2 [
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              "tabla" => array:1 [
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Ultrasound&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Radiograph&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Correct ETT position&#44; n&#47;N</span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCIP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UCIN&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#47;13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;472&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">23&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">22&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;871&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PICU&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;21 &#40;0&#46;17&#8211;0&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;18&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;25 &#40;0&#46;18&#8211;0&#46;40&#41;<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;17&#8211;25&#41;<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">20 &#40;17&#8211;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>&#46;001&nbsp;\t\t\t\t\t\t\n
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                          "etal" => true
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Idiomas
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