Diagnostic Accuracy of a 3-Point Ultrasound Protocol to Detect Esophageal or Endobronchial Mainstem Intubation in a Pediatric Emergency Department
Autor: | Nobuaki Inoue, Osamu Nomura, Yusuke Hagiwara, Takaaki Mori |
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Rok vydání: | 2018 |
Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Point-of-Care Systems Sensitivity and Specificity 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine Tracheotomy Esophagus Clinical Protocols Japan Interquartile range medicine Intubation Intratracheal Intubation Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study Ultrasonography Capnography 030219 obstetrics & reproductive medicine Radiological and Ultrasound Technology medicine.diagnostic_test business.industry Tracheal intubation Infant Reproducibility of Results Emergency department Surgery Respiratory failure Child Preschool Female business Emergency Service Hospital |
Zdroj: | Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in MedicineReferences. 38(11) |
ISSN: | 1550-9613 |
Popis: | Objectives The aim of this study was to evaluate the diagnostic accuracy of the 3-point approach with ultrasonography for confirming endotracheal tube (ETT) placement in pediatric patients. Methods This was a prospective study conducted at a tertiary care center in Japan between March 2014 and March 2016. Children aged 0 to 18 years requiring endotracheal intubation in our emergency department (ED) who underwent ultrasonography for confirming ETT placement were enrolled. Patients who had already undergone a tracheotomy or intubation before arrival at our ED or who had severe neck injuries hindering ultrasonography were excluded. Quantitative capnography and portable chest x-ray imaging were used as the reference standard for the confirmation of proper ETT placement. The main outcome was the diagnostic accuracy of the 3-point approach with ultrasonography for detecting inappropriate ETT placement. Results In total, 68 patients were enrolled. The median age was 17 months (interquartile range, 8-40), and 51.4% were males. Three (4.4%) and 7 (10.3%) patients had esophageal and endobronchial mainstem intubation, respectively. The patients received emergency intubation due to a dysfunction of the central nervous system (45.6%) or respiratory failure (22.0%). The sensitivity and specificity of esophageal versus tracheal intubation was 100% (95% confidence interval [CI], 54.9%-100.0%) and 100% (95% CI, 97.9%-100.0%), respectively, whereas for endobronchial mainstem intubation versus tracheal intubation, the sensitivity and specificity was 85.7% (95% CI, 56.7%-96.0%) and 98.3% (95% CI, 94.8%-99.5%), respectively. Agreement between the reviewers was high (kappa coefficient, 0.78). Conclusion The 3-point approach with ultrasonography was a feasible method for detecting esophageal and endobronchial mainstem intubation in pediatric patients. |
Databáze: | OpenAIRE |
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