Goldberg J S, Rawle P R, Zehnder J L, Sladen R N
Anesthesiology Service, Durham Veterans Administration Medical Center, NC 27705.
Anesth Analg. 1990 Feb;70(2):191-4. doi: 10.1213/00000539-199002000-00011.
We evaluated a colorimetric end-tidal carbon dioxide (ETCO2) detector (FEF end-tidal carbon dioxide detector, Fenem, New York, N.Y.) during 62 intubations in anesthetized patients who were hemodynamically stable. The intubations were performed during a drill that simulates difficult tracheal intubation and therefore is associated with an increased risk of esophageal intubation. Each intubation attempt was monitored by two anesthesiologists and a research assistant who together used chest auscultation, colorimetric ETCO2, and capnography to confirm tracheal intubation and detect esophageal intubation. The reliability of the monitors was compared with capnography. Colorimetric ETCO2 confirmed tracheal intubations and detected esophageal intubations 100% of the time, as judged by capnography. There were no false-positive or false-negative decisions based on endotracheal tube position; however, one equivocal color change occurred, which was caused by failure to inflate the endotracheal tube cuff. Colorimetric ETCO2 monitoring confirmed tracheal intubation more rapidly than did chest auscultation (P less than 0.001) or capnography (P less than 0.05), and detected esophageal intubation more rapidly than did chest auscultation (P less than 0.05) and as rapidly as capnography did. Confirmation of tracheal intubation was achieved earlier than detection of esophageal intubation with all three monitors (P less than 0.05). We conclude that colorimetric ETCO2 monitoring is a safe, reliable, rapid, simple, and portable method for determining endotracheal tube position for patients who are hemodynamically stable and should be recommended where capnography is not available.
我们在62例血流动力学稳定的麻醉患者气管插管过程中，对一种比色法呼气末二氧化碳（ETCO2）检测仪（FEF呼气末二氧化碳检测仪，Fenem公司，纽约州纽约市）进行了评估。这些插管操作是在模拟困难气管插管的演练过程中进行的，因此食管插管风险增加。每次插管尝试都由两名麻醉医生和一名研究助理进行监测，他们共同使用胸部听诊、比色法ETCO2和二氧化碳波形图来确认气管插管并检测食管插管。将这些监测仪的可靠性与二氧化碳波形图进行了比较。根据二氧化碳波形图判断，比色法ETCO2在100%的时间里都能确认气管插管并检测到食管插管。基于气管内导管位置没有出现假阳性或假阴性判断；然而，出现了一次模棱两可的颜色变化，这是由于气管内导管套囊未充气所致。比色法ETCO2监测确认气管插管比胸部听诊（P<0.001）或二氧化碳波形图（P<0.05）更快，检测食管插管比胸部听诊更快（P<0.05），且与二氧化碳波形图一样快。使用所有三种监测仪时，确认气管插管都比检测食管插管更早（P<0.05）。我们得出结论，比色法ETCO2监测是一种安全、可靠、快速、简单且便携的方法，可用于确定血流动力学稳定患者的气管内导管位置，在无法使用二氧化碳波形图的情况下应予以推荐。
