Stewart R D, LaRosee A, Stoy W A, Heller M B
Division of Emergency Medicine, University of Pittsburgh School of Medicine.
Chest. 1987 Nov;92(5):900-3. doi: 10.1378/chest.92.5.900.
Despite the fact that endotracheal intubation is a skill essential for clinicians of varied specialties, the procedure is not without risk, especially when practiced in an emergency setting, particularly the field environment. Of all complications, none is more serious than unrecognized esophageal intubation. Clinical experience with a method of guided orotracheal intubation using a rigid-wire lighted stylet prompted us to develop a technique to confirm correct intratracheal placement of an endotracheal tube using a new flexible lighted stylet designed for nasotracheal intubation. Endotracheal tubes were placed under direct vision at three sites in the upper airway of five unembalmed human cadavers: esophagus (20 cm from the teeth), trachea (20 cm from the teeth) and the right or left pyriform fossa. Thirty-five volunteer intubators were asked to identify tube placement using the transilluminated glow from the flexible nasotracheal lighted stylet. A total of 168 placements were made in 40 trials. Only one of 56 intratracheal placements was misidentified as esophageal. Of 112 extratracheal placements (esophagus or pyriform fossa), one was misidentified as intratracheal. The level of experience or training bore no relationship to the ability of the intubator to identify correct placement. We conclude from the study that this technique is a rapid and reliable method of confirming correct placement of endotracheal tubes. The use of this method could reduce, if not eliminate, unrecognized esophageal intubation in the field, emergency department, the critical care unit, and the operating room.
尽管气管插管是各专业临床医生必备的一项技能，但该操作并非毫无风险，尤其是在紧急情况下进行，特别是在现场环境中。在所有并发症中，没有比未识别出的食管插管更严重的了。使用硬钢丝照明探条进行引导式口气管插管的临床经验促使我们开发一种技术，使用一种专为鼻气管插管设计的新型柔性照明探条来确认气管内导管的正确气管内位置。在五具未防腐处理的人体尸体的上呼吸道三个部位直视下放置气管内导管：食管（距牙齿20厘米处）、气管（距牙齿20厘米处）以及左右梨状窝。35名志愿者插管者被要求利用柔性鼻气管照明探条透照发出的光来确定导管位置。在40次试验中共进行了168次放置。56次气管内放置中只有1次被误判为食管内放置。在112次气管外放置（食管或梨状窝）中，有1次被误判为气管内放置。经验或培训水平与插管者识别正确放置位置的能力无关。我们从该研究得出结论，这项技术是确认气管内导管正确放置的一种快速且可靠的方法。使用这种方法即使不能消除，也可减少现场、急诊科、重症监护病房和手术室中未识别出的食管插管情况。
