Prediction of Endotracheal Tube Depth by Using Deep Convolutional Neural Networks

NCT ID: NCT05085743

Last Updated: 2021-10-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

595 participants

Study Classification

OBSERVATIONAL

Study Start Date

2019-11-01

Study Completion Date

2020-10-31

Brief Summary

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Malposition of an endotracheal tube (ETT) may lead to a great disaster. Developing a handy way to predict the proper depth of ETT fixation is in need. Deep convolutional neural networks (DCNNs) are proven to perform well on chest radiographs analysis. The investigators hypothesize that DCNNs can also evaluate pre-intubation chest radiographs to predict suitable ETT depth and no related studies are found. The authors evaluated the ability of DCNNs to analyze pre-intubation chest radiographs along with patients' data to predict the proper depth of ETT fixation before intubation.

Detailed Description

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This was a retrospective, IRB-approved study using chest radiographs images obtained from Picture Archive and Communication System (PACS) at Chang Gung Memorial Hospital, Linkou branch, Taiwan.

A total of 595 de-identified patients' chest radiographs was obtained for this study. The inclusion criteria for this study are patients 18 years or older who were orotracheal intubated within November 2019 to October 2020 and had taken chest radiographs before and immediately after the intubation (\<24 hours). Both pre-intubation and post-intubation chest radiographs of a same patient were obtained. Clinical data including age, sex, body height, body weight, depth of ETT fixation were also recorded. All ETT tip to carina distance was manually measured by a same anesthesiologist from post-intubation films and documented. Lip to carina length of each patient can be calculated by adding ETT fixation depth and ETT tip to carina distance.

Pre-intubation chest radiographs (n=595) along with clinical data including age, sex, body height, body weight, and measured lip to carina length are collected for model building. For this study, 476/595 (80%) of those were used for training and 119/595 (20%) for validation randomly selected by AI model. In training process, images and related clinical data along with the measured lip to carina length are fed into and used to fit out AI model. Then, in validation process, the investigators evaluate the model accuracy and efficacy of predicting the lip to carina length with images and clinical data of those unforeseen cases.

Conditions

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Intubation Machine Learning

Study Design

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Observational Model Type

CASE_ONLY

Study Time Perspective

RETROSPECTIVE

Study Groups

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Training

Images and related clinical data along with the measured lip to carina length of the training group are fed into and used to fit out deep convolutional neural networks model.

Deep convolutional neural networks analysis

Intervention Type DIAGNOSTIC_TEST

using Deep convolutional neural networks to analyze pre-intubation chest radiographs along with patients' data to predict the proper depth of ETT fixation

Validation

We evaluate the model accuracy and efficacy of predicting the lip to carina length with images and clinical data of those unforeseen cases in the validation group.

Deep convolutional neural networks analysis

Intervention Type DIAGNOSTIC_TEST

using Deep convolutional neural networks to analyze pre-intubation chest radiographs along with patients' data to predict the proper depth of ETT fixation

Interventions

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Deep convolutional neural networks analysis

using Deep convolutional neural networks to analyze pre-intubation chest radiographs along with patients' data to predict the proper depth of ETT fixation

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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Inclusion Criteria

* 18 years or older
* orotracheal intubated within November 2019 to October 2020
* had taken chest radiographs before and within 24hr after intubation

Exclusion Criteria

* Bad chest radiographs quality that patients' carina can not be recognized
* Patient with bronchial insertions found in post-intubation films
* Nasal intubation
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Chang Gung Memorial Hospital

OTHER

Sponsor Role lead

Responsible Party

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Po Jui Chen

medical doctor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Chang Gung Memorial Hospital, Linkou branch

Taoyuan District, Guishan Township, Taiwan

Site Status

Countries

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Taiwan

References

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Lakhani P. Deep Convolutional Neural Networks for Endotracheal Tube Position and X-ray Image Classification: Challenges and Opportunities. J Digit Imaging. 2017 Aug;30(4):460-468. doi: 10.1007/s10278-017-9980-7.

Reference Type BACKGROUND
PMID: 28600640 (View on PubMed)

Lakhani P, Flanders A, Gorniak R. Endotracheal Tube Position Assessment on Chest Radiographs Using Deep Learning. Radiol Artif Intell. 2020 Nov 18;3(1):e200026. doi: 10.1148/ryai.2020200026. eCollection 2021 Jan.

Reference Type BACKGROUND
PMID: 33937852 (View on PubMed)

Eagle CC. The relationship between a person's height and appropriate endotracheal tube length. Anaesth Intensive Care. 1992 May;20(2):156-60. doi: 10.1177/0310057X9202000206.

Reference Type BACKGROUND
PMID: 1595848 (View on PubMed)

Varshney M, Sharma K, Kumar R, Varshney PG. Appropriate depth of placement of oral endotracheal tube and its possible determinants in Indian adult patients. Indian J Anaesth. 2011 Sep;55(5):488-93. doi: 10.4103/0019-5049.89880.

Reference Type BACKGROUND
PMID: 22174466 (View on PubMed)

Techanivate A, Rodanant O, Charoenraj P, Kumwilaisak K. Depth of endotracheal tubes in Thai adult patients. J Med Assoc Thai. 2005 Jun;88(6):775-81.

Reference Type BACKGROUND
PMID: 16083218 (View on PubMed)

Herway ST, Benumof JL. The tracheal accordion and the position of the endotracheal tube. Anaesth Intensive Care. 2017 Mar;45(2):177-188. doi: 10.1177/0310057X1704500207.

Reference Type BACKGROUND
PMID: 28267939 (View on PubMed)

Chong DY, Greenland KB, Tan ST, Irwin MG, Hung CT. The clinical implication of the vocal cords-carina distance in anaesthetized Chinese adults during orotracheal intubation. Br J Anaesth. 2006 Oct;97(4):489-95. doi: 10.1093/bja/ael186. Epub 2006 Jul 27.

Reference Type BACKGROUND
PMID: 16873383 (View on PubMed)

Conrardy PA, Goodman LR, Lainge F, Singer MM. Alteration of endotracheal tube position. Flexion and extension of the neck. Crit Care Med. 1976 Jan-Feb;4(1):8-12. doi: 10.1097/00003246-197601000-00002. No abstract available.

Reference Type BACKGROUND
PMID: 1253616 (View on PubMed)

Other Identifiers

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202002007B0

Identifier Type: -

Identifier Source: org_study_id