Lonchena Tiffany, So Sokpoleak, Ibinson James, Roolf Peter, Orebaugh Steven L
Department of Anesthesiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Center for Emergency Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
J Ultrasound Med. 2017 Feb;36(2):279-284. doi: 10.7863/ultra.16.02010. Epub 2017 Jan 10.
Sonography has been suggested as a possible means of endotracheal tube (ETT) placement confirmation. However, optimum ultrasound transducer placement has not been established. Using a cadaveric model, ETT placement by the sonographic appearance at the thyroid cartilage, cricoid cartilage, and suprasternal notch in the upper airway was assessed to determine which ultrasound transducer placement offered the most optimal images for ETT confirmation in the airway.
One provider intubated 5 cadavers, with the ultrasound transducer at each of the 3 levels, for a total of 30 intubations per specimen, while 2 providers assigned a visual score of 1 (subtle), 2 (clear), or 3 (pronounced) to each sonogram of the ETT in the airway.
At the level of the thyroid cartilage, tracheal intubation was detected at a rate of 40%, with a median visualization scale of 1 (subtle movement). At the level of the cricoid cartilage, the visualization scale improved to a median of 2 (clear movement), with a 70% intubation detection rate. At the level of the suprasternal notch, 100% of the tracheal intubations were visualized on sonography, with a median score of 3 (pronounced movement).
In comparing sonographic detection of ETT placement at 3 levels of the upper airway in a cadaveric model, our results clearly indicate that visualization was superior at the level of the suprasternal notch, with 100% of intubations detected with the best visualization scores.
超声检查已被认为是确认气管内插管（ETT）位置的一种可能方法。然而，最佳超声换能器放置位置尚未确定。本研究使用尸体模型，评估在上气道甲状腺软骨、环状软骨和胸骨上切迹处通过超声图像判断ETT位置，以确定哪种超声换能器放置位置能提供最优化的图像用于气道内ETT位置的确认。
一名操作者对5具尸体进行插管操作，超声换能器分别置于3个水平位置，每个标本共进行30次插管，同时两名操作者对气道内ETT的每个超声图像给予视觉评分，分为1分（模糊）、2分（清晰）或3分（明显）。
在甲状腺软骨水平，气管插管的检测率为40%，可视化评分中位数为1分（轻微移动）。在环状软骨水平，可视化评分中位数提高到2分（清晰移动），插管检测率为70%。在胸骨上切迹水平，超声检查可100%观察到气管插管，评分中位数为3分（明显移动）。
在尸体模型中比较上气道3个水平处ETT位置的超声检测情况，我们的结果清楚地表明，胸骨上切迹水平的可视化效果最佳，100%的插管可被检测到且可视化评分最佳。
