Hutton K C, Verdile V P, Yealy D M, Paris P M
University of Pittsburgh, Pa.
Prehosp Disaster Med. 1990 Apr-Jun;5(2):131-6. doi: 10.1017/s1049023x00026704.
Verification of endotracheal tube (ETT) location in prehospital setting and the emergency department (ED) is a challenging task. Unrecognized esophageal intubations with potentially dangerous consequences may occur more frequently in these environments than in less hectic settings. To evaluate the capabilities of a portable, non-directable, fiberoptic bronchoscope (Visicath; Saratoga Medical, Saratoga, Calif., USA) to detect appropriate ETT placement, a prospective series of 22 intubated prehospital, air-medical, or ED patients underwent fiberoptic verification (FOV) of a newly placed ETT. Each patient was intubated under urgent circumstances. The time required for FOV, ETT location, the relative difficulty of intubation, and the changes in management as a result of FOV were recorded. A total of 24 FOVs were performed, twenty-one tracheal (88%), and two esophageal (8%) intubations were identified. Position could not be identified in one case (4%). FOV confirmed placement in 23 intubations (96%) in less than 25 seconds. Seven intubations (29%) were judged to be "difficult." FOV resulted in five minor changes in management (22%) and was the sole confirmation method for five intubations. We conclude that fiberoptic verification is a promising method of ETT position in air-medical and ED intubations.
在院前环境和急诊科（ED）中，确认气管内插管（ETT）位置是一项具有挑战性的任务。在这些环境中，未被识别的食管插管及其潜在的危险后果可能比在不太繁忙的环境中更频繁地发生。为了评估便携式、非直视光纤支气管镜（Visicath；美国加利福尼亚州萨拉托加市的Saratoga Medical公司）检测ETT正确放置位置的能力，对22例在院前、空中医疗或急诊科进行插管的患者进行了一项前瞻性研究，对新放置的ETT进行了光纤验证（FOV）。每位患者均在紧急情况下进行插管。记录FOV所需时间、ETT位置、插管的相对难度以及FOV导致的管理变化。共进行了24次FOV，其中21次为气管插管（88%），2次为食管插管（8%）。1例（4%）无法确定位置。FOV在不到25秒内确认了23次插管（96%）的位置。7次插管（29%）被判定为“困难”插管。FOV导致5次管理上的轻微变化（22%），并且是5次插管的唯一确认方法。我们得出结论，光纤验证是在空中医疗和急诊科插管中确认ETT位置的一种有前景的方法。
