Alonso Quintela P, Oulego Erroz I, Mora Matilla M, Rodríguez Blanco S, Mata Zubillaga D, Regueras Santos L
Servicio Pediatría, Complejo Asistencial Universitario de León, León, España.
Servicio de Cardiología, Complejo Asistencial Universitario de León, León, España; Unidad de Cuidados Intensivos Pediátricos, Complejo Asistencial Universitario de León, León, España.
An Pediatr (Barc). 2014 Nov;81(5):283-8. doi: 10.1016/j.anpedi.2014.01.004. Epub 2014 Feb 21.
The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns.
Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded.
The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001].
Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.
本研究旨在评估床旁超声与二氧化碳描记法及X线检查相比，在儿童和新生儿气管插管中的应用价值。
纳入在儿科和新生儿重症监护病房进行插管且血流动力学稳定的儿童。每次插管尝试后，同时通过气管超声和二氧化碳描记法检查气管插管情况。然后通过胸部超声评估肺滑动来检查气管插管深度。此后，像往常一样进行胸部X线检查并解读。记录执行每种技术所需的时间。
本研究纳入了26例患者的31次插管（儿科重症监护病房15例，新生儿重症监护病房16例）。在确定正确的气管插管以及评估气管插管深度方面，气管超声与二氧化碳描记法之间或胸部超声与X线检查之间均无统计学显著差异。与二氧化碳描记法相比，超声的敏感性和特异性分别为92%和100%，与X线检查相比分别为100%和75%。与二氧化碳描记法相比，超声明显更慢[12（4 - 16）秒对6（3 - 12）秒；P <.001]，与X线检查相比明显更快[0.22（0.17 - 0.40）对20（17 - 25）分钟，P <.001]。
超声在识别气管插管方面似乎与二氧化碳描记法一样有效，尽管速度较慢。在诸如心肺复苏等二氧化碳描记法不太可靠的临床情况下，超声可能有用。在评估气管插管深度方面，超声与X线检查一样有效且更快，并且可能有助于减少气管插管后X线检查的常规使用。
