Nursing Administration, and the Rebecca C. Considine Research Institute, Akron Children's Hospital, Akron, Ohio.
Center on Bioengineering, University of Texas Medical Branch at Galveston, Galveston, Texas.
Respir Care. 2018 Dec;63(12):1463-1470. doi: 10.4187/respcare.06140. Epub 2018 Jul 31.
Confirmation of endotracheal tube (ETT) tip position and timely identification and correction of malposition is an essential component of care for endotracheally intubated and mechanically ventilated children. We evaluated the ability of a prototype optoacoustic medical device to determine ETT tip position. We hypothesized that the precision of optoacoustic assessment of ETT tip position would be comparable to chest radiography.
We recruited children aged newborn to 16 y who were admitted to the pediatric ICU requiring tracheal intubation and undergoing a chest radiograph for clinical purposes. After positioning each child on a chest radiograph plate, a sterile optical fiber, temporarily inserted through the ETT, emitted laser pulses perpendicular to the fiber and to the ETT, generating acoustic (ultrasound) waves in overlying tissue when the tip of the fiber passed beneath an acoustic sensor in the sternal notch. The distance from the ETT tip to the peak acoustic signal was used to calculate the distance from the ETT tip to the carina, which was compared with the same distance calculated by the radiologist reading the chest radiograph. Pearson's correlation coefficient, paired tests, a Bland-Altman plot were used to compare the measures ( < .05 was considered statistically significant).
Twenty-six subjects were enrolled: 15 (57.7%) were male, median (interquartile range) age, weight, and height were 9 months (4-24), 9.6 kg (5.7-13.0), and 75 cm (62-90), respectively. All ETTs were cuffed (internal diameter range 3.0-5.0 mm). The relationship between optoacoustic and chest radiograph measurements was strong (r = 0.91, < .001). Bias was 0.1 cm with narrow limits of agreement between measures (0.58 cm and 0.76 cm).
The optoacoustic prototype accurately determined ETT tip position and was comparable in precision to chest radiograph.
确认气管内导管（ETT）尖端位置，并及时识别和纠正位置不当，是对气管内插管和机械通气儿童进行护理的重要组成部分。我们评估了一种原型光声医学设备确定 ETT 尖端位置的能力。我们假设光声评估 ETT 尖端位置的精度可与胸部 X 射线摄影相媲美。
我们招募了年龄在新生儿至 16 岁之间的儿童，这些儿童因需要气管插管而入住儿科重症监护病房，并因临床目的进行胸部 X 射线摄影。在将每个孩子放置在胸部 X 射线摄影板上后，一根无菌光纤暂时通过 ETT 插入，垂直于光纤和 ETT 发射激光脉冲，当光纤尖端穿过胸骨切迹中的声学传感器下方时，在覆盖组织中产生声（超声）波。从 ETT 尖端到声信号峰值的距离用于计算从 ETT 尖端到隆嵴的距离，该距离与读取胸部 X 射线摄影的放射科医生计算的相同距离进行比较。使用 Pearson 相关系数、配对检验、Bland-Altman 图来比较这些测量值（<0.05 被认为具有统计学意义）。
共纳入 26 名受试者：15 名（57.7%）为男性，中位数（四分位距）年龄、体重和身高分别为 9 个月（4-24 个月）、9.6kg（5.7-13.0kg）和 75cm（62-90cm）。所有 ETT 均带囊（内径范围 3.0-5.0mm）。光声和胸部 X 射线摄影测量值之间的关系很强（r=0.91，<0.001）。偏差为 0.1cm，两种测量值的一致性界限较窄（0.58cm 和 0.76cm）。
原型光声设备准确确定了 ETT 尖端位置，其精度与胸部 X 射线摄影相当。
