Neethirajan Soma Ganesh Raja, Baskar Ganeshamoorthy, Parameswari Aruna
Sri Ramachandra Institute of Higher Education and Research, Department of Anaesthesiology and Pain Medicine, Chennai, Tamilnadu, India.
Turk J Anaesthesiol Reanim. 2024 Dec 16;52(6):240-246. doi: 10.4274/TJAR.2024.241720.
Successful endotracheal intubation is a key step in advanced airway management. The gold standard confirmation for successful endotracheal intubation is end-tidal carbon dioxide (etCO) monitoring, although recent studies suggest that ultrasound can also be used. In this study, we explored the time-sensitive early recognition of successful endotracheal intubation by comparing ultrasound and etCO monitoring.
The study included 104 patients who were posted for elective surgery under general anaesthesia requiring endotracheal intubation. The time from removal of the face mask to ultrasound visualization of flutter in the trachea was compared with that of the appearance of six consecutive capnography waveforms following endotracheal intubation.
Ultrasound was a faster tool for recognizing successful endotracheal intubation [(21.63±7.38) seconds] compared with capnography [(40.62±7.93) seconds].
eCO requires more time for 6 continuous waveforms to confirm successful intubation and has a false positive rate. Supplementing the gold standard etCO with ultrasound is faster and reliable in patients with low pulmonary blood flow without needing positive pressure ventilation, such as during cardiopulmonary resuscitation, in high-risk emergency intubations, such as in trauma, or in difficult airways where intubation can be confirmed in real time. Ultrasound is a reliable and faster tool for the early identification of successful endotracheal intubation than end-tidal carbon dioxide.
成功的气管插管是高级气道管理的关键步骤。气管插管成功的金标准确认方法是呼气末二氧化碳（etCO）监测，不过最近的研究表明超声也可用于此。在本研究中，我们通过比较超声和etCO监测来探索对气管插管成功的时间敏感性早期识别。
本研究纳入了104例计划在全身麻醉下接受择期手术且需要气管插管的患者。将从移除面罩到超声显示气管内颤动的时间与气管插管后连续出现六个二氧化碳波形图的时间进行比较。
与二氧化碳波形图[（40.62±7.93）秒]相比，超声是识别气管插管成功的更快工具[（21.63±7.38）秒]。
etCO需要更多时间来出现6个连续波形以确认插管成功，且存在假阳性率。在肺血流量低且无需正压通气的患者中，如在心肺复苏期间、在高风险紧急插管（如创伤时）或在困难气道中（可实时确认插管），用超声补充金标准etCO更快且可靠。与呼气末二氧化碳相比，超声是早期识别气管插管成功的可靠且更快的工具。
