Adi Osman, Fong Chan Pei, Sallehuddin Roslanuddin Mohd, Ahmad Azma Haryaty, Sum Kok Meng, Yusof Zulrushdi Md, Via Gabriele, Tavazzi Guido
Resuscitation and Emergency Critical Care Unit (RECCU), Trauma and Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
Trauma and Emergency Department, Hospital Sultanah Bahiyah, Alor Star, Kedah, Malaysia.
Ultrasound J. 2023 May 6;15(1):23. doi: 10.1186/s13089-023-00318-5.
Subglottic secretion had been proven as one of the causes of microaspiration and increased risk of ventilator-associated pneumonia (VAP). The role of ultrasound to detect subglottic secretion has not yet been established.
The purpose of this study is to determine the sensitivity and specificity of upper airway ultrasound (US) in the detection of subglottic secretions as compared to computed tomography (CT) scanning.
A prospective observational study was carried out in adult trauma patients requiring mechanical ventilation and cervical CT scan. All patients had an endotracheal tube cuff-pressure maintained between 20 and 30 cm HO. Airway US was performed at the bedside immediately before the patient was transferred to the CT scan suite. The sensitivity, specificity, and positive/negative predictive values (PPV, NPV) of the upper airway US detection of subglottic secretions were then calculated and compared with CT findings.
Fifty participants were consecutively included. Subglottic secretions were detected in 31 patients using upper airway US. The sensitivity and specificity of upper airway US in detecting subglottic secretion were 96.7% and 90%, respectively (PPV 93.5%, NPV 94.7%). 18 (58%) patients with subglottic secretions developed VAP during their ICU stay (p = 0.01). The area under the receiver operating curve (AUROC) was 0.977 (95% CI 0.936-1.00).
Upper airway US is a useful tool for detecting subglottic secretions with high sensitivity and specificity.
This study shows: 1. Upper airway US may aid in detecting subglottic secretions, which are linked to VAP. 2. Detecting subglottic secretions at the bedside aids in determining the best frequency of subglottic aspiration to clean the subglottic trachea. 3. Upper airway US may also aid in detecting the correct ETT position. Trial registration Clinicaltrials.gov.
gov identifier NCT04739878 Date of registration 2nd May 2021 URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT04739878 .
声门下分泌物已被证明是微误吸的原因之一，也是呼吸机相关性肺炎（VAP）风险增加的原因之一。超声检测声门下分泌物的作用尚未明确。
本研究的目的是确定与计算机断层扫描（CT）相比，上气道超声（US）检测声门下分泌物的敏感性和特异性。
对需要机械通气和进行颈椎CT扫描的成年创伤患者进行了一项前瞻性观察研究。所有患者的气管插管套囊压力维持在20至30cmH₂O之间。在患者被转移到CT扫描室之前，立即在床边进行气道超声检查。然后计算上气道超声检测声门下分泌物的敏感性、特异性以及阳性/阴性预测值（PPV、NPV），并与CT结果进行比较。
连续纳入50名参与者。使用上气道超声在31例患者中检测到声门下分泌物。上气道超声检测声门下分泌物的敏感性和特异性分别为96.7%和90%（PPV为93.5%，NPV为94.7%）。18例（58%）有声门下分泌物的患者在重症监护病房住院期间发生了VAP（p = 0.01）。受试者工作特征曲线下面积（AUROC）为0.977（95%CI 0.936 - 1.00）。
上气道超声是一种检测声门下分泌物的有用工具，具有高敏感性和特异性。
本研究表明：1. 上气道超声可能有助于检测与VAP相关的声门下分泌物。2. 在床边检测声门下分泌物有助于确定最佳的声门下吸引频率，以清洁声门下气管。3. 上气道超声也可能有助于检测气管插管的正确位置。试验注册Clinicaltrials.gov。
gov标识符NCT04739878 注册日期2021年5月2日 试验注册记录的网址https://clinicaltrials.gov/ct2/show/NCT04739878 。
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