Akutcentrum/Anestesikliniken, Skåne University Hospital, SUS, Malmø, Sweden.
Acta Anaesthesiol Scand. 2011 Nov;55(10):1190-5. doi: 10.1111/j.1399-6576.2011.02501.x. Epub 2011 Sep 8.
This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation.
A prospective, paired, and investigator-blinded study carried out in the operating theatre. Twenty-five adult patients requiring endotracheal intubation were included. During intubation, transtracheal ultrasound was performed to visualize passage of the endotracheal tube. During bag ventilation, bilateral lung ultrasound was performed for the detection of lung sliding as a sign of ventilation simultaneous with capnography and auscultation of the epigastrium and chest. Primary outcome measure was time difference to confirmed endotracheal intubation between ultrasound and auscultation alone. Secondary outcome measure was time difference between ultrasound and auscultation combined with capnography.
Both methods verified endotracheal tube placement in all patients. In 68% of patients, endotracheal tube placement was visualized by real-time transtracheal ultrasound. Comparing ultrasound with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for ultrasound was 40 s [interquartile range (IQR) 35-48 s] vs. 48 s (IQR 45-53 s), P < 0.0001. Mean difference was -7.1 s in favour of ultrasound [95% confidence interval (CI) -9.4--4.8 s]. No significant difference was found between ultrasound compared with auscultation alone. Median time for auscultation alone was 42 s (IQR 37-47 s), P = 0.6, with a mean difference of -0.88 s in favour of ultrasound (95% CI -4.2-2.5 s).
Verification of endotracheal tube placement with ultrasound is as fast as auscultation alone and faster than the standard method of auscultation and capnography.
本研究比较了经胸超声与听诊和呼气末二氧化碳监测用于验证气管插管的时间消耗。
在手术室进行前瞻性、配对和观察者盲法研究。纳入 25 例需要气管插管的成年患者。在插管过程中，经气管超声用于可视化气管导管的通过。在气囊通气期间，进行双侧肺超声以检测肺滑动作为与呼气末二氧化碳监测和上腹部及胸部听诊同时通气的标志。主要结局指标为超声与单独听诊确认气管插管之间的时间差异。次要结局指标为超声与听诊联合呼气末二氧化碳监测之间的时间差异。
两种方法均在所有患者中验证了气管导管的位置。在 68%的患者中，实时经气管超声可见气管导管位置。与听诊联合呼气末二氧化碳监测相比，超声与两种方法之间存在显著差异。超声的中位时间为 40 秒[四分位间距（IQR）35-48 秒]，而听诊联合呼气末二氧化碳监测的中位时间为 48 秒（IQR 45-53 秒），P<0.0001。超声的平均差值为-7.1 秒，有利于超声[95%置信区间（CI）-9.4-4.8 秒]。与单独听诊相比，超声无显著差异。单独听诊的中位时间为 42 秒（IQR 37-47 秒），P=0.6，超声的平均差值为-0.88 秒，有利于超声[95%CI-4.2-2.5 秒]。
用超声验证气管插管位置与单独听诊一样快，比听诊和呼气末二氧化碳监测的标准方法更快。
