Department of Anaesthesia, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
Department of Anaesthesia, Warrington Hospital, Warrington, UK.
Br J Hosp Med (Lond). 2023 Mar 2;29(3):1-9. doi: 10.12968/hmed.2023.0007. Epub 2023 Mar 29.
Major harm from unrecognised oesophageal intubation continues, despite the 2018 Royal College of Anaesthetists' 'no trace, wrong place' campaign. It is likely that publicly reported cases represent a fraction of real occurrences. This article summarises a 2022 consensus guideline on the prevention of unrecognised oesophageal intubation from the Project for Universal Management of Airway and international airway societies. The guideline is written for all airway operators and assistants, in any clinical setting, and readers are advised to deepen their understanding by studying the original guideline. The recommendations include how to avoid and recognise oesophageal intubation as well as a set of logical actions to take when it is a plausible possibility, even if it is not suspected. The guideline emphasises the importance of videolaryngoscopy, capnography and oxygen saturation monitoring for all tracheal intubations, wherever performed. It introduces the concept of sustained exhaled carbon dioxide, which is central to identifying oesophageal intubation, and acting to prevent progression to unrecognised oesophageal intubation. In the absence of sustained exhaled carbon dioxide, the default action is to remove the tube. This will mean some tracheal placed tubes are removed but based on a risk-benefit analysis, this is desirable. The tube should only be left in place if there is clear danger in removing it and in this event, its position should be confirmed, using repeat videolaryngoscopy plus one other of bronchoscopy, skilled ultrasound or use of an oesophageal detector device. The importance of human factors is underlined; for instance, the value of a shared and vocalised report of videolaryngoscopy view and trained assistants working with the operator to confirm whether the criteria for sustained exhaled carbon dioxide are met, to minimise error and improve team working.
尽管 2018 年皇家麻醉师学院开展了“无痕迹，错误位置”运动，但未被识别的食管插管仍造成严重伤害。公众报告的案例可能只是实际发生的一小部分。本文总结了 2022 年关于预防未被识别的食管插管的共识指南，该指南来自气道通用管理项目和国际气道协会。该指南适用于任何临床环境中的所有气道操作人员和助手，建议读者通过研究原始指南来加深对该指南的理解。该指南包括如何避免和识别食管插管，以及在可能出现食管插管时应采取的一系列逻辑操作，即使没有怀疑也是如此。该指南强调了在任何进行气管插管的情况下使用视频喉镜、二氧化碳描记图和氧饱和度监测的重要性。它引入了持续呼气二氧化碳的概念，这是识别食管插管并采取措施防止进展为未被识别的食管插管的核心。在没有持续呼气二氧化碳的情况下，默认操作是移除导管。这意味着一些气管内放置的导管会被移除，但基于风险效益分析，这是可取的。只有在移除导管存在明显危险的情况下，才应将导管留在原处，在这种情况下，应使用重复的视频喉镜检查加支气管镜检查、熟练的超声检查或使用食管探测器设备来确认其位置。强调了人为因素的重要性；例如，报告视频喉镜视图的共享和发声、经过培训的助手与操作人员合作以确认是否满足持续呼气二氧化碳的标准的价值，以减少错误并提高团队合作。
