Section of Trauma, Surgical Critical Care and Surgical Emergencies, Department of Surgery, Yale School of Medicine, New Haven, Connecticut 06520-8062, USA.
J Trauma Acute Care Surg. 2013 Jul;75(1):146-9. doi: 10.1097/ta.0b013e31829849cd.
Suboptimal positioning of endotracheal tubes (ETs) is often identified on routine chest radiographs prompting adjustment. The accuracy of ET adjustments based on tube measurement markings at the incisors has not been reported.
We performed a 1-year prospective observational study of all surgical intensive care unit patients requiring repositioning of their ET based on chest x-ray (CXR) study. The ET was repositioned by a respiratory therapist using tube markings at the incisors, and follow-up CXR images were obtained within 2 hours. ET tube locations were compared with the planned intervention. Mean, median, interquartile range (IQR) and [chi]2 results are reported.
Fifty-five patients met inclusion criteria and had a complete set of data (80% male). ET advancement was the most commonly required intervention (80%). For advancement, the median starting position was 7.10 cm (IQR, 2.20 cm) from the carina, with a median planned advancement of 2.00 cm. The actual advancement was a median of 1.15 cm, achieving 57.5% of the goal. Patients requiring ET withdrawal were more likely female (8 of 11, p < 0.001). For the withdrawal group, the median starting position was 0.70 cm (IQR, 1.05 cm) from the carina with a planned median withdrawal of 2.00 cm (IQR, 0.75 cm). The actual withdrawal was a median of 1.00 cm, achieving 50.0% of the goal. Overall, the mean difference between the planned and actual intervention was 1.55 cm (95% confidence interval, 1.16-1.95 cm) differing by a mean of 40% from the planned intervention (95% confidence interval, 29.0-51.0%). There was no correlation between the original location or the planned intervention and the accuracy of the intervention. In three cases, the ET moved opposite of the planned intervention.
ET repositioning based on measurement at the incisors is inaccurate and the magnitude of the intervention does not correlate with the degree of error. Repositioning of ETs based on measurements at the incisors should be abandoned, or follow-up CXR images should be obtained.
在常规胸部 X 光片上经常发现气管内导管（ET）的位置不理想，从而需要进行调整。但目前尚未报道过基于切牙处的管测量标记来调整 ET 的准确性。
我们对所有因胸部 X 光片（CXR）研究而需要重新定位 ET 的外科重症监护病房患者进行了为期 1 年的前瞻性观察研究。呼吸治疗师使用切牙处的管标记来重新定位 ET，并在 2 小时内获得后续的 CXR 图像。将 ET 管位置与计划干预进行比较。报告均值、中位数、四分位距（IQR）和[chi]2 结果。
55 名患者符合纳入标准并具有完整的数据（80%为男性）。最常需要的干预措施是 ET 推进（80%）。对于推进，起始位置的中位数为 7.10cm（IQR，2.20cm），计划推进距离为 2.00cm。实际推进距离为 1.15cm，达到目标距离的 57.5%。需要 ET 拔出的患者更可能为女性（8/11，p<0.001）。对于拔出组，起始位置的中位数为 0.70cm（IQR，1.05cm），计划中位数为 2.00cm（IQR，0.75cm）。实际拔出距离的中位数为 1.00cm，达到目标距离的 50.0%。总体而言，计划干预与实际干预之间的平均差异为 1.55cm（95%置信区间，1.16-1.95cm），与计划干预的平均差异为 40%（95%置信区间，29.0-51.0%）。原始位置或计划干预与干预的准确性之间没有相关性。在三种情况下，ET 移动的方向与计划干预相反。
基于切牙处测量来重新定位 ET 是不准确的，并且干预的幅度与误差程度无关。应放弃基于切牙处测量来重新定位 ET，或应获得后续的 CXR 图像。
