Maskay Shirish Shakti, Shrestha Ninadini, Bastola Priska, Pradhan Bishwas, Shrestha Anil
Department of Anesthesiology, Indira Gandhi Memorial Hospital, Male, Maldives.
Department of Anesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
J Med Ultrasound. 2023 Nov 10;32(1):70-75. doi: 10.4103/jmu.jmu_98_22. eCollection 2024 Jan-Mar.
There is continued research to find new faster, highly accurate, easily accessible, and portable methods of confirming endotracheal tube position during intubation. A newer modality for visualizing endotracheal tube location is transtracheal or transcricothyroid ultrasonography. The aim of this study was to see if ultrasound machine can also be routinely used for the confirmation of endotracheal tube position in operating theaters along with capnograph.
The study was observational and prospective, conducted from January 2017 to July 2017. Study locations were at the Tribhuvan University Teaching Hospital and Manmohan Cardiothoracic Vascular and Transplant Center operating rooms. Sample size taken was 95.
In the study, 11 patients had esophageal intubation out of the 95. The accuracy of both ultrasonography and capnography was found to be 96.84%. For ultrasonography, the sensitivity, specificity, along with positive predictive value and negative predictive value were 97.62%, 90.91%, 98.80%, and 83.33%, respectively, while that for capnography were found to be 96.43%, 100%, 100%, and 78.57%, respectively. The kappa value was calculated to be 0.749, which suggested the degree of agreement of result between the methods to be good. Compared to capnography, ultrasonography was found to be significantly faster for the confirmation of endotracheal tube location by 16.36 s (15.70-17.02) ( = 0.011).
Both waveform capnography and ultrasonography were found to be accurate and reliable in confirming endotracheal tube location. The use of ultrasound during intubation can help confirm endotracheal tube location faster and also aid in precision when used along with capnography. Manual bag ventilations are not necessary when confirming endotracheal tube position by ultrasonography and thus may help in preventing aspiration of gastric contents into the lungs of the patient.
人们一直在持续研究，以寻找新的、更快、高度准确、易于获取且便于携带的方法，用于在插管过程中确认气管内导管位置。一种用于可视化气管内导管位置的更新模式是经气管或经环甲膜超声检查。本研究的目的是探讨超声仪是否也能与二氧化碳波形图仪一起，在手术室中常规用于确认气管内导管位置。
本研究为观察性前瞻性研究，于2017年1月至2017年7月进行。研究地点为特里布万大学教学医院和曼莫汉心胸血管与移植中心的手术室。样本量为95例。
在该研究中，95例患者中有11例发生食管插管。超声检查和二氧化碳波形图检查的准确率均为96.84%。对于超声检查，其敏感性、特异性、阳性预测值和阴性预测值分别为97.62%、90.91%、98.80%和83.33%，而对于二氧化碳波形图检查，分别为96.43%、100%、100%和78.57%。计算得出的kappa值为0.749，这表明两种方法结果的一致性程度良好。与二氧化碳波形图检查相比，超声检查在确认气管内导管位置方面明显更快，快16.36秒（15.70 - 17.02）（P = 0.011）。
波形二氧化碳图检查和超声检查在确认气管内导管位置方面均准确可靠。插管过程中使用超声有助于更快地确认气管内导管位置，并且与二氧化碳波形图仪一起使用时有助于提高准确性。通过超声检查确认气管内导管位置时无需手动进行球囊通气，因此可能有助于防止胃内容物误吸到患者肺部。
