Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA.
Department of Emergency Medicine, Wellspan York Hospital, York, PA, USA.
Am J Emerg Med. 2014 Mar;32(3):267-9. doi: 10.1016/j.ajem.2013.11.032. Epub 2013 Nov 26.
Transtracheal ultrasound has been described as a method to evaluate endotracheal tube placement. Correlation between sonologist experience and the successful use of transtracheal ultrasound to identify endotracheal tube location has not been examined. Our objectives were to evaluate emergency physicians' ability to correctly identify endotracheal tube location using transtracheal ultrasound and to evaluate the role operator experience plays in successful identification of tube placement.
This was a cross-sectional, single-blinded study conducted in a cadaver laboratory. Two cadavers were used as models. One cadaver had an endotracheal tube placed in the esophagus, and the second had the tube placed in the trachea. Participants were asked to evaluate tube placement using transtracheal ultrasound and to record their interpretation. Examination clips were reviewed by the emergency ultrasound fellowship director. Descriptive statistics and χ(2) test were used for analysis.
Twenty-nine participants were included, 8 (27.6%) of whom were considered to be "most experienced" based on previous ultrasound experience (>150 scans). Eleven of 29 correctly identified esophageal intubation and 18 of 29 correctly identified tracheal intubation, resulting in a sensitivity of 62.0% (95% confidence interval [CI], 42.3-79.3) and a specificity of 37.9% (95% CI, 20.7-57.7). Transtracheal ultrasound performed by the most experienced sonologists showed better sensitivity and specificity, 75.0% (95% CI, 34.9-96.8) and 62.5% (95% CI, 24.5-91.5), respectively.
Most participants obtained adequate images, but correct interpretation of the images was poor. The most experienced sonologists correctly identified tube location more often. Additional education would be required before adopting this method.
经气管超声已被描述为一种评估气管内导管放置的方法。尚未检查超声医师经验与经气管超声成功识别气管内导管位置之间的相关性。我们的目的是评估急诊医师使用经气管超声正确识别气管内导管位置的能力，并评估操作人员经验在成功识别管放置中的作用。
这是一项在尸体实验室进行的横断面、单盲研究。使用了两个尸体作为模型。一个尸体的气管内导管放置在食管中，第二个尸体的气管内导管放置在气管中。参与者被要求使用经气管超声评估管的位置，并记录他们的解释。由急诊超声研究员审查检查剪辑。使用描述性统计和 χ(2)检验进行分析。
共纳入 29 名参与者，其中 8 名（27.6%）根据之前的超声经验（>150 次扫描）被认为是“最有经验”。29 名参与者中有 11 名正确识别出食管插管，18 名正确识别出气管插管，敏感性为 62.0%（95%置信区间[CI]，42.3-79.3），特异性为 37.9%（95% CI，20.7-57.7）。最有经验的超声医师进行的经气管超声显示出更好的敏感性和特异性，分别为 75.0%（95% CI，34.9-96.8）和 62.5%（95% CI，24.5-91.5）。
大多数参与者获得了足够的图像，但对图像的正确解释很差。最有经验的超声医师更经常正确识别管位置。在采用这种方法之前，需要进行额外的教育。
