Chowdhury Apala Roy, Punj Jyotsna, Pandey R, Darlong V, Sinha Renu, Bhoi D
Department of Anesthesiology, All India Institute of Medical Sciences, New Delhi, India.
Saudi J Anaesth. 2020 Jan-Mar;14(1):15-21. doi: 10.4103/sja.SJA_180_19. Epub 2020 Jan 6.
Anesthesia trainee may initially take longer time to intubate and unintentionally place the endotracheal tube (ETT) in the esophagus. The present study determined if ultrasound is the fastest method of confirmation of correct placement of ETT compared to capnography, and chest auscultation in trainees.
First year anesthesia residents performed intubation in 120 patients recruited after ethical clearance and informed consent. Time to visualize flutter in trachea, double trachea sign, time to appearance of first and sixth capnography, and time to execute chest auscultation was noted.
Ultrasonography was statistically fastest method to determine endotracheal intubation (36.50 ± 15.14 seconds) vs unilateral chest auscultation (50.29 ± 15.50 seconds) vs bilateral chest auscultation (51.90 ± 15.98 seconds) vs capnography first waveform (53.57 ± 15.97 seconds) vs capnography sixth waveform (61.67 ± 15.88 seconds).
When teaching endotracheal intubation to novice anesthesia residents using conventional direct laryngoscopy, ultrasonography is the fastest method to confirm correct ETT placement compared to capnograph and chest auscultation. Mentor can guide trainee to direct ETT towards trachea and can promptly detect esophageal intubation by double trachea sign.
麻醉实习生最初可能需要更长时间进行气管插管，并且可能无意中将气管内导管（ETT）置入食管。本研究确定与二氧化碳波形图和胸部听诊相比，超声是否是确认实习生正确放置ETT的最快方法。
在获得伦理批准并取得知情同意后，招募了120例患者，由第一年的麻醉住院医师进行插管。记录观察到气管内颤动、双气管征的时间，首次和第六次二氧化碳波形图出现的时间，以及进行胸部听诊的时间。
统计学上，超声是确定气管插管最快的方法（36.50±15.14秒），其次是单侧胸部听诊（50.29±15.50秒）、双侧胸部听诊（51.90±15.98秒）、二氧化碳波形图第一个波形（53.57±15.97秒）、二氧化碳波形图第六个波形（61.67±15.88秒）。
在使用传统直接喉镜向新手麻醉住院医师教授气管插管时，与二氧化碳波形图和胸部听诊相比，超声是确认ETT正确放置的最快方法。带教老师可以指导实习生将ETT对准气管，并可通过双气管征迅速检测到食管插管。
