Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
J Emerg Med. 2020 Aug;59(2):254-264. doi: 10.1016/j.jemermed.2020.04.040. Epub 2020 Jun 14.
The integration of point-of-care ultrasound in endotracheal tube placement confirmation has been focus of many recent studies.
We sought to determine the diagnostic accuracy of ultrasonography in confirmation of endotracheal intubation compared with standard confirmatory methods.
We completed an extensive search of PubMed, EMBASE, Cochrane Central, Web of Science, and bibliographies of the selected articles from inception to October 2019. The search was limited to prospective studies conducted in human adults that compared the accuracy of ultrasonography in confirming the endotracheal tube position with a reference standard. The methodologic quality of studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A bivariate random-effects model summarized diagnostic accuracy statistics. Subgroup analyses by ultrasonographic signs, study location, the operator's specialty, types of transducer, the technique of ultrasound confirmation, and clinical setting (cardiac arrest vs. non-cardiac arrest) were performed.
Thirty studies involving 2534 patients were selected for this meta-analysis. The estimated pooled sensitivity and specificity for ultrasonography were 0.982 (95% confidence interval [CI] 0.971-0.988) and 0.957 (95% CI 0.901-0.982), respectively. Subgroup analyses did not reveal significant difference by ultrasonographic sign used, location, the sonographer's specialty, transducer type, or ultrasound technique used. Ultrasound was also found to be a useful adjunct in confirming endotracheal tube position in the subgroup of patients with cardiac arrest, with sensitivity of 0.99 (95% CI 0.98-1.00) and specificity of 0.84 (95% CI 0.67-1.00), respectively.
Ultrasonography is a valuable and reliable adjunct for endotracheal tube confirmation, including during cardiac arrest resuscitation.
床边超声在气管插管位置确认中的应用一直是许多近期研究的焦点。
我们旨在确定超声在确认气管插管方面的诊断准确性，与标准确认方法相比。
我们对 PubMed、EMBASE、Cochrane 中心、Web of Science 以及从研究开始到 2019 年 10 月选定文章的参考文献进行了广泛的搜索。搜索仅限于在成年人类中进行的前瞻性研究，这些研究比较了超声在确认气管内管位置方面的准确性与参考标准。使用诊断准确性研究质量评估工具-2 评估研究的方法学质量。使用双变量随机效应模型总结诊断准确性统计数据。按超声征象、研究地点、操作者专业、换能器类型、超声确认技术和临床环境（心搏骤停与非心搏骤停）进行亚组分析。
共有 30 项研究涉及 2534 名患者，被纳入本次荟萃分析。超声的估计合并敏感性和特异性分别为 0.982（95%置信区间 0.971-0.988）和 0.957（95%置信区间 0.901-0.982）。按超声征象、研究地点、操作者专业、换能器类型或使用的超声技术进行亚组分析，未见显著差异。在心搏骤停患者亚组中，超声也被发现是确认气管内管位置的有用辅助手段，其敏感性为 0.99（95%置信区间 0.98-1.00），特异性为 0.84（95%置信区间 0.67-1.00）。
超声是一种有价值且可靠的气管插管确认辅助手段，包括在心脏骤停复苏期间。
