Marmara University Faculty of Medicine, Department of Emergency Medicine, Istanbul, Turkey.
Ministry of Health Fatih Sultan Mehmet Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
Am J Emerg Med. 2018 Nov;36(11):1943-1946. doi: 10.1016/j.ajem.2018.02.015. Epub 2018 Feb 17.
Confirmation of the endotracheal tube placement (CoETP) has the utmost importance in the management of an airway. Visualization of tracheal rings or carina with a fiber-optical bronchoscope (FOB) has considered to be a reliable method for the CoETP. However, FOB is expensive, time-consuming, and not always practical. Inexpensive endoscopic USB-cameras were shown to aid intubation successfully and reliably. On the other hand, there have been no studies investigating their use for the CoETP. Tracheal ultrasonography (TUS) is also a new, inexpensive and widely available alternative. A cadaver study has planned to evaluate the diagnostic utility of TUS and a USB-camera.
This study was conducted in the Anatomy Lab of a University on a fresh frozen female cadaver. Three senior Emergency Physicians have intubated the cadaver, and performed TUS or USB-endoscopy. We have prepared a randomized intubation list (n=96) in three blocks (3 times 32) as to include equal number of esophageal and tracheal intubations (48 for each). Each EP is performed all three interventions (intubation, TUS and USB-endoscopy) in consecutive blocks of 32 intubations, in turn. The position of the tube has been verified from a 2cm wide ostium on the proximal trachea.
In this study, all intubations (n=96, 100%) were correctly identified as tracheal or esophageal with both TUS and USB-camera. Both the sensitivity and specificity of TUS and USB-endoscopy for the CoETP were 100.0%.
The perfect accuracy of TUS and USB-endoscopy, have placed those techniques in a unique position as an alternative in resource-poor situations.
确认气管内导管位置（CoETP）在气道管理中至关重要。使用纤维光学支气管镜（FOB）观察气管环或隆突被认为是 CoETP 的可靠方法。然而，FOB 昂贵、耗时，并不总是实用。廉价的内镜 USB 摄像头已被证明可成功且可靠地辅助插管。另一方面，尚未有研究调查它们在 CoETP 中的使用。经气管超声（TUS）也是一种新的、廉价且广泛可用的替代方法。一项尸体研究计划评估 TUS 和 USB 摄像头的诊断效用。
本研究在一所大学的解剖实验室的一具新鲜冷冻女性尸体上进行。三名资深急诊医生对尸体进行了插管，并进行了 TUS 或 USB 内镜检查。我们准备了一份随机插管清单（n=96），分为三个块（3 次 32 次），以包括相等数量的食管和气管插管（各 48 次）。每位 EP 医生在连续的 32 次插管块中依次进行所有三种干预（插管、TUS 和 USB 内镜检查）。管的位置已通过近端气管上 2cm 宽的口进行验证。
在这项研究中，所有插管（n=96，100%）均通过 TUS 和 USB 摄像头正确识别为气管或食管。TUS 和 USB 内镜检查对 CoETP 的敏感性和特异性均为 100.0%。
TUS 和 USB 内镜检查的完美准确性使这些技术在资源匮乏的情况下处于独特的替代地位。
