Bhende M S, Thompson A E, Orr R A
Department of Pediatrics, University of Pittsburgh, School of Medicine, Children's Hospital of Pittsburgh, PA 15213-2583.
Pediatrics. 1992 Jun;89(6 Pt 1):1042-4.
Critically ill children often require endotracheal intubation prior to transport to a medical center. Correct endotracheal tube placement and maintenance during transport are essential. The utility of a portable colorimetric end-tidal CO2 detector during transport of critically ill children was evaluated. Fifty-eight children with spontaneous circulation (aged 1 day to 12 years, weight 0.9 to 26 kg) who underwent 59 intubations during transport by ground (n = 31) or air (n = 27) were studied. Tube position was confirmed by physical examination, arterial blood gas values, or arterial oxygen saturation, and sometimes by chest radiography. The detector was attached and readings were obtained after intubation; readings were repeated if endotracheal tube position was rechecked during transport. Fifty-seven of 58 tracheal positions and the 1 esophageal tube position were correctly identified. One false-negative result occurred in a severely hypocarbic 900-g premature newborn. On each occasion that the detector was used en route, the endotracheal tube position was correctly identified. It is concluded that the end-tidal CO2 detector is a useful tool for confirming endotracheal tube position during transport of critically ill children weighing more than 2 kg who are not in cardiopulmonary arrest.
危重症患儿在转运至医疗中心之前通常需要进行气管插管。在转运过程中正确放置和维护气管导管至关重要。我们评估了便携式比色法呼气末二氧化碳检测仪在危重症患儿转运过程中的效用。研究对象为58名有自主循环的儿童（年龄1天至12岁，体重0.9至26千克），他们在地面（n = 31）或空中（n = 27）转运期间接受了59次插管。通过体格检查、动脉血气值或动脉血氧饱和度，有时还通过胸部X线检查来确认导管位置。插管后连接检测仪并获取读数；如果在转运过程中重新检查气管导管位置，则重复读数。58个气管位置中的57个以及1个食管导管位置被正确识别。在一名严重低碳酸血症的900克早产新生儿中出现了1例假阴性结果。在每次途中使用检测仪时，气管导管位置均被正确识别。结论是，呼气末二氧化碳检测仪是确认体重超过2千克且未发生心肺骤停的危重症患儿在转运过程中气管导管位置的有用工具。
