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 Dec;62:9-13. doi: 10.1016/j.ajem.2022.09.033. Epub 2022 Sep 29.
Endotracheal intubation is commonly performed in the Emergency Department. Traditional measures for estimating and confirming the endotracheal tube (ETT) depth may be inaccurate or lead to delayed recognition. Ultrasound may offer a rapid tool to confirm ETT depth at the bedside.
This was a randomized trial assessing the diagnostic accuracy of ultrasound to confirm ETT depth. Three cadavers were intubated in a random sequence with the ETT placed high (directly below the vocal cords), middle (2 cm above the carina), or deep (ETT at the carina). Seven blinded sonographers assessed the depth of the ETT using ultrasound. Outcomes included diagnostic accuracy of sonographer identification, time to identification, and operator confidence based upon ETT location. A subgroup analysis was performed to assess diagnostic accuracy by operator confidence.
441 total assessments were performed (154 high, 154 middle, and 133 deep ETT placements). Overall accuracy was 84.8% (95% CI 81.1% to 88.0%). When placed high, ultrasound was 82.5% sensitive (95% CI 75.5% to 88.1%) and 92.3% specific (95% CI 88.6% to 95.1%) with a mean time to identification of 15.3 s (95% CI 13.6-17.0) and a mean operator confidence of 3.9/5.0 (95% CI 3.7-4.1). When the ETT was placed in the middle, ultrasound was 83.8% sensitive (95% CI 77.0% to 89.2%) and 92.3% specific (95% CI 88.6% to 95.1%) with a mean time to identification of 16.7 s (95% CI 14.6-18.8) and a mean operator confidence of 3.7/5.0 (95% CI 3.5-3.9). When the ETT was placed deep, ultrasound was 88.0% sensitive (95% CI 81.2% to 93.0%) and 92.2% specific (95% CI 88.6% to 94.6%) with a mean time to identification of 19.0 s (95% CI 17.3-20.7) and a mean operator confidence of 3.4/5.0 (95% CI 3.2-3.6). Sonographers were significantly more accurate when they reported a higher confidence score.
Ultrasound was moderately accurate for identifying the ETT location in a cadaveric model and was more accurate when sonographers felt confident with their visualization. Future research should determine the accuracy of combining transtracheal ultrasound with lung sliding and other modifications to improve the accuracy.
气管插管在急诊科中经常进行。传统的估计和确认气管内导管（ETT）深度的方法可能不准确或导致识别延迟。超声可能提供一种在床边快速确认 ETT 深度的工具。
这是一项评估超声确认 ETT 深度的诊断准确性的随机试验。将三个尸体随机顺序插管，ETT 放置在高位（直接在声带下方）、中位（隆突上方 2 厘米）或低位（ETT 在隆突处）。七名盲法超声医师使用超声评估 ETT 深度。结果包括超声医师识别的诊断准确性、识别时间和基于 ETT 位置的操作者信心。进行了亚组分析，以评估根据操作者信心的诊断准确性。
共进行了 441 次总评估（高位 154 次，中位 154 次，低位 ETT 放置 133 次）。总体准确性为 84.8%（95%CI 81.1%至 88.0%）。当 ETT 放置在高位时，超声的灵敏度为 82.5%（95%CI 75.5%至 88.1%），特异性为 92.3%（95%CI 88.6%至 95.1%），平均识别时间为 15.3 秒（95%CI 13.6-17.0），平均操作者信心为 3.9/5.0（95%CI 3.7-4.1）。当 ETT 放置在中位时，超声的灵敏度为 83.8%（95%CI 77.0%至 89.2%），特异性为 92.3%（95%CI 88.6%至 95.1%），平均识别时间为 16.7 秒（95%CI 14.6-18.8），平均操作者信心为 3.7/5.0（95%CI 3.5-3.9）。当 ETT 放置在低位时，超声的灵敏度为 88.0%（95%CI 81.2%至 93.0%），特异性为 92.2%（95%CI 88.6%至 94.6%），平均识别时间为 19.0 秒（95%CI 17.3-20.7），平均操作者信心为 3.4/5.0（95%CI 3.2-3.6）。当超声医师对其可视化结果有信心时，他们的诊断准确性显著提高。
在尸体模型中，超声对确定 ETT 位置具有中等准确性，并且当超声医师对其可视化结果有信心时，准确性更高。未来的研究应确定结合经气管超声与肺滑动和其他改良方法以提高准确性的准确性。
