Ramsingh Davinder, Frank Ethan, Haughton Robert, Schilling John, Gimenez Kimberly M, Banh Esther, Rinehart Joseph, Cannesson Maxime
From the Department of Anesthesiology and Perioperative Care, University of California, Irvine, Irvine, California (D.R., E.F., R.H., J.S., K.M.G., E.B., J.R.); and Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Irvine, Los Angeles, California (M.C.).
Anesthesiology. 2016 May;124(5):1012-20. doi: 10.1097/ALN.0000000000001073.
Unrecognized malposition of the endotracheal tube (ETT) can lead to severe complications in patients under general anesthesia. The focus of this double-blinded randomized study was to assess the accuracy of point-of-care ultrasound in verifying the correct position of the ETT and to compare it with the accuracy of auscultation.
Forty-two adult patients requiring general anesthesia with ETT were consented. Patients were randomized to right main bronchus, left main bronchus, or tracheal intubation. After randomization, the ETT was placed via fiber-optic visualization. Next, the location of the ETT was assessed using auscultation by a separate blinded anesthesiologist, followed by an ultrasound performed by a third blinded anesthesiologist. Ultrasound examination included assessment of tracheal dilation via cuff inflation with air and evaluation of pleural lung sliding. Statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value, and interobserver agreement for the ultrasound examination (95% CI).
In differentiating tracheal versus bronchial intubations, auscultation showed a sensitivity of 66% (0.39 to 0.87) and a specificity of 59% (0.39 to 0.77), whereas ultrasound showed a sensitivity of 93% (0.66 to 0.99) and specificity of 96% (0.79 to 1). Identification of tracheal versus bronchial intubation was 62% (26 of 42) in the auscultation group and 95% (40 of 42) in the ultrasound group (P = 0.0005) (CI for difference, 0.15 to 0.52), and the McNemar comparison showed statistically significant improvement with ultrasound (P < 0.0001). Interobserver agreement of ultrasound findings was 100%.
Assessment of trachea and pleura via point-of-care ultrasound is superior to auscultation in determining the location of ETT.
气管内插管（ETT）位置未被识别可导致全身麻醉患者出现严重并发症。这项双盲随机研究的重点是评估床旁超声在验证ETT正确位置方面的准确性，并将其与听诊的准确性进行比较。
42例需要全身麻醉并进行ETT插管的成年患者签署了知情同意书。患者被随机分为右主支气管、左主支气管或气管插管组。随机分组后，通过纤维光学可视化放置ETT。接下来，由一名独立的盲法麻醉医生通过听诊评估ETT的位置，随后由第三名盲法麻醉医生进行超声检查。超声检查包括通过向气囊充气评估气管扩张以及评估胸膜肺滑动。统计分析包括超声检查的敏感性、特异性、阳性预测值、阴性预测值以及观察者间一致性（95%CI）。
在区分气管插管与支气管插管方面，听诊的敏感性为66%（0.39至0.87），特异性为59%（0.39至0.77），而超声的敏感性为93%（0.66至0.99），特异性为96%（0.79至1）。听诊组气管插管与支气管插管的识别率为62%（42例中的26例），超声组为95%（42例中的40例）（P = 0.0005）（差异的CI为0.15至0.52），McNemar比较显示超声检查有统计学意义的改善（P < 0.0001）。超声检查结果的观察者间一致性为100%。
在确定ETT位置方面，通过床旁超声评估气管和胸膜优于听诊。
