Stanford University School of Medicine, Department of Emergency Medicine, Palo Alto, California.
Stanford University School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Palo Alto, California.
West J Emerg Med. 2020 Jul 10;21(4):871-876. doi: 10.5811/westjem.2020.5.45588.
Grayscale ultrasound (US) imaging has been used as an adjunct for confirming endotracheal tube (ETT) placement in recent years. The addition of color Doppler imaging (CDI) has been proposed to improve identification but has not been well studied. The aim of this study was to assess whether CDI improves correct localization of ETT placement.
A convenience sample of emergency and critical care physicians at various levels of training and experience participated in an online assessment. Participants viewed US video clips of patients, which included either tracheal or esophageal intubations captured in grayscale or with CDI; there were five videos of each for a total of 20 videos. Participants were asked to watch each clip and then assess the location of the ETT.
Thirty-eight subjects participated in the online assessment. Levels of training included medical students (13%), emergency medicine (EM) residents (50%), EM attendings (32%), and critical care attendings (5%). The odds ratio of properly assessing tracheal placement using color relative to a grayscale imaging technique was 1.5 (p = 0.21). Regarding the correct assessment of esophageal placement, CDI had 1.4 times the odds of being correctly assessed relative to grayscale (p = 0.26). The relationship between training level and correct assessments was not significant for either tracheal or esophageal placements.
In this pilot study we found no significant improvement in correct identification of ETT placement using color Doppler compared to grayscale ultrasound; however, there was a trend toward improvement that might be better elucidated in a larger study.
近年来，灰阶超声（US）成像已被用作确认气管内导管（ETT）位置的辅助手段。添加彩色多普勒成像（CDI）已被提议用于提高识别能力，但尚未得到充分研究。本研究旨在评估 CDI 是否能改善 ETT 放置的正确定位。
在不同培训和经验水平的急诊和重症监护医师中，采用便利抽样法参与了在线评估。参与者观看了包含气管或食管插管的 US 视频剪辑，这些剪辑分别以灰阶或 CDI 拍摄；总共有 20 个视频，每个视频 5 个。参与者被要求观看每个视频片段，然后评估 ETT 的位置。
共有 38 名受试者参加了在线评估。培训水平包括医学生（13%）、急诊医学住院医师（50%）、急诊医学主治医生（32%）和重症监护主治医生（5%）。使用彩色多普勒相对于灰阶成像技术正确评估气管位置的优势比为 1.5（p=0.21）。关于正确评估食管位置，CDI 相对于灰阶的正确评估的可能性是其 1.4 倍（p=0.26）。对于气管或食管的正确评估，培训水平与正确评估之间的关系均不显著。
在这项初步研究中，我们发现与灰阶超声相比，彩色多普勒在正确识别 ETT 放置方面没有显著改善；然而，在更大的研究中可能会更好地阐明这种改善的趋势。
