Zamani Majid, Esfahani Mohammad Nasr, Joumaa Ibrahim, Heydari Farhad
Department of Emergency Medicine, Emergency Medicine Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2018 Jun 25;7:95. doi: 10.4103/abr.abr_179_17. eCollection 2018.
A secure airway and effective ventilation are key components of advanced life support, and misplacement of endotracheal tube (ETT) can lead to morbidity in multiple trauma patients. The purpose of this study was to investigate the accuracy of ultrasound in diagnosis of direction for tracheal intubation.
This descriptive-analytical study was conducted on 100 traumatic patients requiring intubation in 2016 in the Emergency Department of Al-Zahra and Kashani Medical Education Centers in Isfahan. Surface probe was placed transversally in the front of the neck at the top of the suprasternal notch, and the position of trachea was specified by front of comet-tail artifact which is the contour between hyperechoic air-mucosa (A-M) and a posterior reverberation artifact. Intubation accuracy by capnography was investigated, and the results were recorded in each patient's profile. Tracheal sonography was done during placement, or as soon as, the ETT has been embedded. The scanning time was minimized and it was carried out in total time of 10 s.
The diagnosis of intubation accuracy indicated that it was successful in 94 individuals (94%) and unsuccessful in 6 ones (6%). Intubation accuracy in 93 people (93%) was confirmed, and inaccuracy of intubation in 7 people (7%) was diagnosed. Ultrasound sensitivity in diagnosis of intubation accuracy was 97.9% (92.94) with 83.3% (5.6%) specificity. The positive and negative predictive values were 98.9% (92.93) and 71.4% (5.7%) respectively.
Ultrasound method has high sensitivity and specificity to determine the correct placement of the tracheal tube, and it can be implemented as a reliable method given the acceptable positive and negative predictive values.
安全气道和有效通气是高级生命支持的关键组成部分，气管内插管（ETT）位置不当可导致多发伤患者发病。本研究的目的是探讨超声在诊断气管插管方向方面的准确性。
本描述性分析研究于2016年在伊斯法罕的阿尔-扎赫拉和卡沙尼医学教育中心急诊科对100例需要插管的创伤患者进行。将表面探头横向置于胸骨上切迹顶部的颈部前方，通过彗尾伪像前方来确定气管位置，彗尾伪像是高回声空气-黏膜（A-M）与后方混响伪像之间的轮廓。通过二氧化碳波形图研究插管准确性，并将结果记录在每位患者的资料中。在放置ETT期间或ETT置入后立即进行气管超声检查。扫描时间减至最短，总时间为10秒。
插管准确性诊断显示，94例（94%）成功，6例（6%）失败。93例（93%）插管准确得到确认，7例（7%）插管不准确被诊断出来。超声诊断插管准确性的敏感性为97.9%（92.94），特异性为83.3%（5.6%）。阳性和阴性预测值分别为98.9%（92.93）和71.4%（5.7%）。
超声方法在确定气管导管正确位置方面具有高敏感性和特异性，鉴于其可接受的阳性和阴性预测值，可作为一种可靠方法实施。
