Roy Purbali S, Joshi Nandkishore, Garg Monika, Meena Reema, Bhati Sushil
Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
Indian J Anaesth. 2022 Dec;66(12):826-831. doi: 10.4103/ija.ija_240_22. Epub 2022 Dec 20.
In emergency airway management, unstable haemodynamics of the patients calls for the early need to detect correct endotracheal tube (ETT) placement. Ultrasonography has an advantage of being readily available along with being non-invasive and providing real time images. We aimed to study the usefulness of tracheal ultrasonography and use it as a tool to assess correct tracheal intubation in patients in the intensive care unit.
This was a hospital-based observational study. The study included 92 patients who needed and were taken up for endotracheal intubation. Tube placement was confirmed simultaneously by three different observers with their respective method, i.e., ultrasonography, clinical method and capnography.
Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography against capnography were 100% each with value of 1. However, for clinical method against capnography, the sensitivity was 96.5%, specificity 28.6%, PPV 94.3% and NPV 40% with value of 0.727. Mean time taken to detect correct placement of the ETT by ultrasonography, capnography and clinical method was 4.93 s, 15.39s and 17.80s, respectively. Out of 92 intubations, 85 were tracheal and 7 were oesophageal. All intubations were detected accurately with ultrasonography and capnography, ultrasonography being faster. Clinical method correctly detected 82 out of 85 tracheal intubations and 2 out of 7 oesophageal intubations, and was therefore less accurate than the other two methods.
The study shows that ultrasonography is as reliable a method for confirmation of endotracheal intubation as capnography and is more reliable than clinical method. Besides, ultrasonography is faster than the other two methods.
在紧急气道管理中，患者不稳定的血流动力学状况要求尽早检测气管内导管（ETT）的正确置入情况。超声检查具有随时可用、非侵入性且能提供实时图像的优势。我们旨在研究气管超声检查的实用性，并将其作为评估重症监护病房患者气管插管是否正确的工具。
这是一项基于医院的观察性研究。该研究纳入了92例需要并接受气管插管的患者。由三名不同的观察者分别使用各自的方法（即超声检查、临床方法和二氧化碳波形图）同时确认导管的置入情况。
超声检查相对于二氧化碳波形图的灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）均为100%，kappa值为1。然而，临床方法相对于二氧化碳波形图的灵敏度为96.5%，特异度为28.6%，PPV为94.3%，NPV为40%，kappa值为0.727。通过超声检查、二氧化碳波形图和临床方法检测到ETT正确置入的平均时间分别为4.93秒、15.39秒和17.80秒。在92次插管中，85次为气管插管，7次为食管插管。超声检查和二氧化碳波形图能准确检测出所有插管情况，且超声检查速度更快。临床方法正确检测出了85次气管插管中的82次以及7次食管插管中的2次，因此不如其他两种方法准确。
该研究表明，超声检查在确认气管插管方面与二氧化碳波形图一样可靠，且比临床方法更可靠。此外，超声检查比其他两种方法更快。
