Lotano R, Gerber D, Aseron C, Santarelli R, Pratter M
Cooper Hospital/University Medical Center, and University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, Camden, New Jersey 08103, USA.
Crit Care. 2000;4(1):50-3. doi: 10.1186/cc650. Epub 2000 Jan 24.
To determine the clinical usefulness of immediate (stat) chest radiographs after endotracheal intubation when performed by experienced critical care personnel.
This was a prospective study. Endotracheal intubations in an 11-bed intensive care unit and a nine-bed intermediate intensive care unit were included. After intubations were performed by an experienced critical care operator, that individual recorded demographic and procedural data, and predicted radiographic findings on a data collection sheet. Experience at intubation was stratified into four levels of lifetime experience: fewer than 10 procedures, 10-20 procedures, 20-50 procedures, and more than 50 procedures. Radiographic findings evaluated included endotracheal tube position and procedure-related complications. The postintubation chest radiograph was then reviewed and the actual findings were also recorded.
A total of 101 evaluable intubations were recorded, two of which were predicted to show tube malposition. Actual radiographic findings revealed 10 malpositions, three of which were too high and seven were too low (one at the level of the carina). A single witnessed aspiration that occurred during intubation was not radiographically apparent until 24 h later. Only the tube positioned at the carina was felt to be of acute clinical significance or to place the patient at any acute risk.
The incidence of endotracheal tube malposition after intubation was underestimated. However, when performed by experienced critical care personnel, acutely significant malpositions were rare (one out of 101 intubations). We conclude that, in the absence of specific pulmonary complications, endotracheal intubations performed by experienced operators may be followed by routine, rather than 'stat' chest radiographs.
确定由经验丰富的重症监护人员进行气管插管后立即拍摄胸部X光片的临床实用性。
这是一项前瞻性研究。纳入了一个拥有11张床位的重症监护病房和一个拥有9张床位的中级重症监护病房的气管插管病例。在由经验丰富的重症监护操作人员完成插管后，该人员记录人口统计学和操作数据，并在数据收集表上预测X光检查结果。插管经验分为四个终身经验水平：少于10次操作、10 - 20次操作、20 - 50次操作以及超过50次操作。评估的X光检查结果包括气管插管位置和与操作相关的并发症。然后对插管后的胸部X光片进行复查，并记录实际结果。
共记录了101次可评估的插管，其中两次预计显示插管位置不当。实际X光检查结果显示有10次位置不当，其中3次过高，7次过低（1次位于隆突水平）。插管期间发生的一次明显误吸直到24小时后才在X光片上显现出来。只有位于隆突处的插管被认为具有急性临床意义或使患者处于任何急性风险中。
插管后气管插管位置不当的发生率被低估了。然而，当由经验丰富的重症监护人员进行操作时，具有急性显著意义的位置不当情况很少见（101次插管中有1次）。我们得出结论，在没有特定肺部并发症的情况下，由经验丰富的操作人员进行气管插管后，可进行常规而非即时胸部X光检查。
