颈部床旁超声可在紧急气管插管时确认气管内导管位置。
Bedside ultrasound of the neck confirms endotracheal tube position in emergency intubations.
作者信息
Hoffmann B, Gullett J P, Hill H F, Fuller D, Westergaard M C, Hosek W T, Smith J A
机构信息
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston.
Emergency Medicine, University of Alabama at Birmingham.
出版信息
Ultraschall Med. 2014 Oct;35(5):451-8. doi: 10.1055/s-0034-1366014. Epub 2014 Jul 11.
PURPOSE
In controlled environments such as the operating room, bedside ultrasound (BUS) of the neck has shown high accuracy for distinguishing endotracheal (ETI) from esophageal intubations. We sought to determine the accuracy of BUS for endotracheal tube (ETT) position in the emergency department (ED) setting.
MATERIALS AND METHODS
We assessed the utility of BUS in a single-center observational study in an ED setting. BUS was performed either simultaneously with ED intubation (S/ED), within < 3 minutes of ED intubation (A/ED), or in < 3 minutes of patient's ED arrival after pre-hospital intubation (A/EMS). Trained ED providers performed BUS; intubators were blinded to ultrasound findings. We used Cormack and Lehane categories (CL) to classify intubation attempts as "easy" (CL-I/II), "moderate" (CL-III) and "difficult" (CL-IV). Additional data included the diagnostic accuracy of the sonographer and intubator compared to the clinical outcome, anatomy identified by sonography and time to diagnosis.
RESULTS
During a 10-month period, 89 subjects with 115 intubation attempts were included in the study, and 86 patients/101 attempts with complete data were used in the study (63-easy, 19-moderate, 19-difficult). The sonographers achieved 100 % accuracy with respect to determining the correct ETT position utilizing an anterior neck approach, while the intubators' accuracy in assessing correct tube location was 97 % compared to the clinical outcome. A blinded review of sonography findings confirmed all BUS anatomical findings. A sonographically empty esophagus was 100 % specific for endotracheal intubation, and a "double trachea sign" was 100 % sensitive and 91 % specific for esophageal intubation. The sonographic time to diagnosis was significantly faster than the intubator time to diagnosis ("easy" p < 0.001; n = 47; "moderate" p = 0.001; n = 15; "difficult" p < 0.001; n = 19); Wilcoxon test; A/EMS cases excluded).
CONCLUSION
In this emergency setting, ultrasound determined ETT locations rapidly with 100 % accuracy and independently of the CL-category.
目的
在手术室等受控环境中，颈部床边超声（BUS）已显示出在区分气管内插管（ETI）和食管插管方面具有很高的准确性。我们试图确定在急诊科（ED）环境中BUS对气管内导管（ETT）位置判断的准确性。
材料与方法
我们在一个急诊科环境的单中心观察性研究中评估了BUS的效用。BUS在急诊科插管同时进行（S/ED）、在急诊科插管后<3分钟内进行（A/ED）或在院前插管后患者到达急诊科<3分钟内进行（A/EMS）。经过培训的急诊科工作人员进行BUS检查；插管人员对超声检查结果不知情。我们使用科马克和莱汉内分级（CL）将插管尝试分为“容易”（CL-I/II）、“中等”（CL-III）和“困难”（CL-IV）。其他数据包括超声检查人员和插管人员与临床结果相比的诊断准确性、超声检查识别的解剖结构以及诊断时间。
结果
在10个月期间，研究纳入了89名受试者的115次插管尝试，86名患者/101次尝试有完整数据用于研究（63次容易，19次中等，19次困难）。超声检查人员采用前颈部方法确定正确ETT位置的准确率为100%，而插管人员评估导管正确位置的准确率与临床结果相比为97%。对超声检查结果的盲法审查证实了所有BUS解剖学发现。超声显示食管空虚对气管内插管的特异性为100%，“双气管征”对食管插管的敏感性为100%，特异性为91%。超声诊断时间明显快于插管人员的诊断时间（“容易”p<0.001；n = 47；“中等”p = 0.001；n = 15；“困难”p<0.001；n = 19）；威尔科克森检验；排除A/EMS病例）。
结论
在这种急诊环境中，超声能快速且准确地确定ETT位置，准确率达100%，且与CL分级无关。
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