{"title":"气道超声在确认重症儿童气管插管深度方面的诊断准确性","authors":"","doi":"10.1016/j.ajem.2024.08.012","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Chest X-ray, the established standard of confirming endotracheal tube (ETT) position, has important drawbacks including radiation exposure. Point-of-care airway ultrasound, which has been insufficiently studied in children, can overcome these problems.</p></div><div><h3>Materials and methods</h3><p>This was a prospective cross-sectional study done on children aged 2 months to 17 years undergoing intubation with cuffed ETT in the PICU. The ETT cuff was filled with saline and three ultrasonographic techniques were used– <em>1)</em> Suprasternal (SS) method <em>2)</em> Cricoid (CC) metho and <em>3)</em> Tracheal ring (TR) method. Position of the ETT as determined by ultrasound and X-ray were compared. The main outcomes were sensitivity, specificity, and area under curve (AUC) for ultrasound-based methods vs. X-ray. For the TR method, concordance between the X-ray and ultrasound categories were taken.</p></div><div><h3>Results</h3><p>Total 62 patients were enrolled. The sensitivity and specificity of SS method were 71% (95% CI: 57–83%) and 100% (40–100%). The CC distance method had an AUC of 0.94 (95% CI: 0.86, 1.0). In the TR method, 98% of correct position on X-ray were correctly classified by USG. The agreement between X-ray and ultrasound categories with the cuff between the first and third tracheal rings, was very good [kappa (95% CI): 0.87 (0.70, 1.00), <em>p</em> ≤0.001)].</p></div><div><h3>Conclusion</h3><p>Bedside ultrasound is a good method to confirm ETT depth in children. The tracheal ring method had the best diagnostic accuracy and is easy to perform. The new method using cricoid cuff distance needs further validation in different ICU settings.</p></div>","PeriodicalId":55536,"journal":{"name":"American Journal of Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":2.7000,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diagnostic accuracy of airway ultrasound in confirming the endotracheal tube depth in critically ill children\",\"authors\":\"\",\"doi\":\"10.1016/j.ajem.2024.08.012\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Chest X-ray, the established standard of confirming endotracheal tube (ETT) position, has important drawbacks including radiation exposure. Point-of-care airway ultrasound, which has been insufficiently studied in children, can overcome these problems.</p></div><div><h3>Materials and methods</h3><p>This was a prospective cross-sectional study done on children aged 2 months to 17 years undergoing intubation with cuffed ETT in the PICU. The ETT cuff was filled with saline and three ultrasonographic techniques were used– <em>1)</em> Suprasternal (SS) method <em>2)</em> Cricoid (CC) metho and <em>3)</em> Tracheal ring (TR) method. Position of the ETT as determined by ultrasound and X-ray were compared. The main outcomes were sensitivity, specificity, and area under curve (AUC) for ultrasound-based methods vs. X-ray. For the TR method, concordance between the X-ray and ultrasound categories were taken.</p></div><div><h3>Results</h3><p>Total 62 patients were enrolled. The sensitivity and specificity of SS method were 71% (95% CI: 57–83%) and 100% (40–100%). The CC distance method had an AUC of 0.94 (95% CI: 0.86, 1.0). In the TR method, 98% of correct position on X-ray were correctly classified by USG. The agreement between X-ray and ultrasound categories with the cuff between the first and third tracheal rings, was very good [kappa (95% CI): 0.87 (0.70, 1.00), <em>p</em> ≤0.001)].</p></div><div><h3>Conclusion</h3><p>Bedside ultrasound is a good method to confirm ETT depth in children. The tracheal ring method had the best diagnostic accuracy and is easy to perform. The new method using cricoid cuff distance needs further validation in different ICU settings.</p></div>\",\"PeriodicalId\":55536,\"journal\":{\"name\":\"American Journal of Emergency Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-08-14\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American Journal of Emergency Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0735675724003991\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0735675724003991","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
背景胸部 X 光检查是确认气管导管(ETT)位置的既定标准,但存在辐射等重要缺点。材料和方法这是一项前瞻性横断面研究,研究对象是在重症监护病房接受带袖带 ETT 插管的 2 个月至 17 岁儿童。ETT 袖套内注入生理盐水,并使用三种超声波技术:1)胸骨上(SS)法;2)环状(CC)法;3)气管环(TR)法。对超声和 X 光确定的 ETT 位置进行了比较。主要结果是超声法与 X 光法的灵敏度、特异性和曲线下面积(AUC)。对于 TR 方法,X 射线和超声类别之间的一致性被考虑在内。SS 方法的敏感性和特异性分别为 71%(95% CI:57-83%)和 100%(40-100%)。CC 距离法的 AUC 为 0.94 (95% CI: 0.86, 1.0)。在 TR 方法中,X 光片上 98% 的正确位置被 USG 正确分类。X 射线和超声分类与第一和第三气管环之间的袖带之间的一致性非常好[kappa (95% CI): 0.87 (0.70, 1.00), p ≤0.001]。气管环法的诊断准确率最高,且操作简便。使用环状袖带距离的新方法需要在不同的重症监护室环境中进一步验证。
Diagnostic accuracy of airway ultrasound in confirming the endotracheal tube depth in critically ill children
Background
Chest X-ray, the established standard of confirming endotracheal tube (ETT) position, has important drawbacks including radiation exposure. Point-of-care airway ultrasound, which has been insufficiently studied in children, can overcome these problems.
Materials and methods
This was a prospective cross-sectional study done on children aged 2 months to 17 years undergoing intubation with cuffed ETT in the PICU. The ETT cuff was filled with saline and three ultrasonographic techniques were used– 1) Suprasternal (SS) method 2) Cricoid (CC) metho and 3) Tracheal ring (TR) method. Position of the ETT as determined by ultrasound and X-ray were compared. The main outcomes were sensitivity, specificity, and area under curve (AUC) for ultrasound-based methods vs. X-ray. For the TR method, concordance between the X-ray and ultrasound categories were taken.
Results
Total 62 patients were enrolled. The sensitivity and specificity of SS method were 71% (95% CI: 57–83%) and 100% (40–100%). The CC distance method had an AUC of 0.94 (95% CI: 0.86, 1.0). In the TR method, 98% of correct position on X-ray were correctly classified by USG. The agreement between X-ray and ultrasound categories with the cuff between the first and third tracheal rings, was very good [kappa (95% CI): 0.87 (0.70, 1.00), p ≤0.001)].
Conclusion
Bedside ultrasound is a good method to confirm ETT depth in children. The tracheal ring method had the best diagnostic accuracy and is easy to perform. The new method using cricoid cuff distance needs further validation in different ICU settings.
期刊介绍:
A distinctive blend of practicality and scholarliness makes the American Journal of Emergency Medicine a key source for information on emergency medical care. Covering all activities concerned with emergency medicine, it is the journal to turn to for information to help increase the ability to understand, recognize and treat emergency conditions. Issues contain clinical articles, case reports, review articles, editorials, international notes, book reviews and more.