Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
Am J Emerg Med. 2022 Aug;58:131-134. doi: 10.1016/j.ajem.2022.05.053. Epub 2022 Jun 2.
After intubation has been performed, it is important to rapidly confirm the correct location of the endotracheal tube (ETT). Multiple techniques have been described, each with different limitations. Ultrasound has been increasingly recognized as an alternate modality for identifying the ETT location. However, it can be challenging to visualize the air-filled ETT cuff. Saline insufflation of the ETT cuff has been suggested to improve visualization of the ETT but data are limited. Our study sought to compare the diagnostic accuracy of air versus saline ETT cuff inflation on the diagnostic accuracy of intubation.
This was a randomized trial comparing air versus saline cuff inflation using a cadaver model. Adult cadavers were intubated in a random sequence with respect to both the location of intubation (i.e., tracheal vs esophageal) and air versus saline. Blinded sonographers assessed the location of the ETT using the static technique. Outcomes included accuracy of sonographer identification, time to identification, and operator confidence.
480 total assessments were performed. When using air, ultrasound was 95.8% sensitive (95% CI 90.5% to 98.6%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 8.5 s (95% CI 7.6 s to 9.4 s) and a mean operator confidence of 4.32/5.0 (95% CI 4.21 to 4.42). When using saline, ultrasound was 100% sensitive (95% CI 97.0% to 100%) and 100% specific (95% CI 97.0% to 100%) with a mean time to confirmation of 6.3 s (95% CI 5.9 s to 6.8 s) and a mean operator confidence of 4.52/5.0 (95% CI 4.44 to 4.60).
There was no statistically significant difference between air versus saline for intubation confirmation. However, saline was associated with fewer false negatives. Additionally, time to confirmation was faster and operator confidence was higher with the saline group. Further studies should determine if the outcomes would change with more novice sonographers or in specific patient populations.
气管插管后，迅速确认气管内导管（ETT）的正确位置非常重要。已经描述了多种技术，每种技术都有不同的局限性。超声已越来越被认为是识别 ETT 位置的替代方法。然而，要可视化充满空气的 ETT 套囊可能具有挑战性。有人建议向 ETT 套囊内注入生理盐水以改善 ETT 的可视化，但数据有限。我们的研究旨在比较空气与生理盐水 ETT 套囊充气对插管诊断准确性的影响。
这是一项在尸体模型中比较空气与生理盐水套囊充气的随机试验。成人尸体以插管位置（气管 vs 食管）和空气与生理盐水的随机顺序进行插管。盲法超声医师使用静态技术评估 ETT 的位置。结果包括超声医师识别的准确性、识别时间和操作者信心。
共进行了 480 次总评估。使用空气时，超声的灵敏度为 95.8%（95%CI 90.5%至 98.6%），特异性为 100%（95%CI 97.0%至 100%），确认时间的平均值为 8.5 秒（95%CI 7.6 秒至 9.4 秒），操作者信心的平均值为 4.32/5.0（95%CI 4.21 至 4.42）。使用生理盐水时，超声的灵敏度为 100%（95%CI 97.0%至 100%），特异性为 100%（95%CI 97.0%至 100%），确认时间的平均值为 6.3 秒（95%CI 5.9 秒至 6.8 秒），操作者信心的平均值为 4.52/5.0（95%CI 4.44 至 4.60）。
空气与生理盐水在插管确认方面没有统计学上的显著差异。然而，生理盐水与较少的假阴性有关。此外，生理盐水组的确认时间更快，操作者信心更高。进一步的研究应确定在经验较少的超声医师或特定患者群体中，结果是否会发生变化。
