Brun Pierre-Marie, Chenaitia Hichem, Lablanche Christophe, Pradel Anne-Lise, Deniel Cécile, Bessereau Jacques, Melaine Régis
Department of Emergency Medicine and Intensive Care, Desgenettes Military Hospital, Lyon, France.
Prehospital Emergency Medical Services of Marine Fire Battalion, Marseille, France.
Mil Med. 2014 Sep;179(9):959-63. doi: 10.7205/MILMED-D-14-00044.
X-ray remains the "gold standard" test to control the gastric tube (GT) position. The aim of this study is to estimate the diagnostic accuracy of a 2-point ultrasonography to confirm GT placement in the prehospital setting.
The emergency physician performed an ultrasound examination during GT insertion. The aim was to determine whether or not the GT could be viewed in the esophagus and/or in the stomach.
Thirty-two intubated patients were included. In 100% of cases, the GT was instantly identified by ultrasound at esophagus and in 62.5% at stomach. In 6 cases, the GT was not seen in the stomach, but the injection of air through the GT allowed to confirm intragastric position in 2 cases. In the 4 other cases, no dynamic fogging was observed. In hospital X-ray control confirmed the correct positioning of 28/32.
The 2-point ultrasonographic live control of the GT position has a better sensitivity and a much higher specificity than the syringe test but similar to the xiphoid ultrasound control. However, our method allows to show the GT in the esophagus and to use the dynamic ultrasound fogging to reveal an intragastric position that was not obvious with the common techniques.
X线仍然是控制胃管（GT）位置的“金标准”检查。本研究的目的是评估两点超声检查在院前环境中确认GT放置位置的诊断准确性。
急诊医生在插入GT期间进行超声检查。目的是确定在食管和/或胃中是否能看到GT。
纳入32例插管患者。100%的病例中，超声能立即在食管中识别出GT，62.5%的病例中能在胃中识别出。6例中，胃内未见GT，但通过GT注入空气在2例中证实胃内位置。其他4例中，未观察到动态气过水声。住院期间X线检查证实32例中有28例定位正确。
两点超声实时控制GT位置比注射器试验具有更高的敏感性和特异性，与剑突下超声检查相似。然而，我们的方法能够显示食管内的GT，并利用动态超声气过水声揭示普通技术难以明确的胃内位置。
