Emergency Physician–Verified Out-of-hospital Intubation: Miss Rates by Paramedics

Jones, James H.; Murphy, Michael P.; Dickson, Robert; Somerville, Geoff G.; Brizendine, Edward J.

doi:10.1111/j.1553-2712.2004.tb00730.x

Cited by 20 publications

(22 citation statements)

References 11 publications

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“…1 Rates of ETT misplacement in those arriving to emergency depart ments already intubated range from 5.8% to 18%. [2][3] Moreover, the presence of end-tidal CO 2 , the gold standard for confirmation of ETT placement, has been observed in mal-positioned ETTs. [2][3] Particularly in prehospital and operational settings, confirmation of prop er ETT placement can be challenging.…”

Section: Introductionmentioning

confidence: 99%

“…[2][3] Moreover, the presence of end-tidal CO 2 , the gold standard for confirmation of ETT placement, has been observed in mal-positioned ETTs. [2][3] Particularly in prehospital and operational settings, confirmation of prop er ETT placement can be challenging. Ultrasound (US), and more specifi- cally, portable, hand-held, ultrasound (PHHU), is a light weight, diagnostic modality that is being used increasingly by clinicians to provide an additional sensory modality to the physical examination.…”

Section: Introductionmentioning

confidence: 99%

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Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

Chun¹,

Kirkpatrick²,

Sirois³

et al. 2004

Prehosp. Disaster med.

121

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Introduction:The diagnosis of endotracheal tube (ETT) mal-position may be delayed in extreme environments. Several methods are utilized to confirm proper ETT placement, but these methods can be unreliable or unavailable in certain settings. Thoracic sonography, previously utilized to detect pneumothoraces, has not been tested to assess ETT placement.Hypothesis:Thoracic sonography could correlate with pulmonary ventilation, and thereby, help to confirm proper ETT placement.Methods:Thirteen patients requiring elective intubation under general anesthesia, and data from two trauma patients were evaluated. Using a portable, hand-held, ultrasound (PHHU) machine, sonographic recordings of the chest wall visceral-parietal pleural interface (VPPI) were recorded bilaterally in each patient during all phases of airway management: (1) preoxygenation; (2) induction; (3) paralysis; (4) intubation; and (5) ventilation. Results: The VPPI could be well-imaged for all of the patients. In the two trauma patients, right mainstem intubations were noted in which specific pleural signals were not seen in the left chest wall VPPI after tube placement. These signs returned after correct repositioning of the ETT tube. In all of the elective surgery patients, signs correlating with bilateral ventilation in each patient were imaged and correlated with confirmation of ETT placement by anesthesiology.Conclusions:This report raises the possibility that thoracic sonography may be another tool that could be used to confirm proper ETT placement. This technique may have merit in extreme environments, such as in remote, prehospital settings or during aerospace medical transports, in which auscultation is impossible due to noise, or capnography is not available, and thus, requires further scientific evaluation.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

Chun¹,

Kirkpatrick²,

Sirois³

et al. 2004

Prehosp. Disaster med.

121

View full text Add to dashboard Cite

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“…Трахеотрубка остается оптимальным методом управления дыханием при остановке сердца. Но достоверно, что без адекватного обучения и опыта процент осложнений -таких, как нераспознанная интубация пищевода (6-14% по данным отдельных исследований) [132][133][134][135] и смещение положения трубки, неприемлемо высоки. 136 Слишком длительное время трахеоинтубации дает усугубляет гипоксию, перерыв в проведении компрессии грудной клетки на время интубации ухудшает коронарный и мозговой кровоток.…”

Section: альтернативные устройства интубированияunclassified

4

2008

Seven Wheelchairs

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“…The most serious of these complications is esophageal intubation, which occurs at incidences as high as 6% to 16%. 1,2 If esophageal intubation is not confirmed early, treatment can be delayed, even for life-threatening conditions. 3,4 Current guidelines recommend that the ETT position should be confirmed as soon as possible while minimizing interference with other rescue efforts.…”

Section: Introductionmentioning

confidence: 99%

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

Chen

Wang

et al. 2019

J Int Med Res

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Objective Critically ill patients often require emergency endotracheal intubation and mechanical ventilation. When esophageal intubation is not confirmed early, treatment may be delayed, even for life-threatening conditions. We examined the accuracy of bedside real-time airway ultrasonography in confirming the endotracheal tube (ETT) position during emergency endotracheal intubation in patients in the intensive care unit (ICU). Methods This single-center prospective observational study included 118 patients who underwent urgent endotracheal intubation in the ICU of Taizhou Hospital of Integrated Traditional Chinese and Western Medicine. Tracheal ultrasonography was used to confirm the ETT position during endotracheal intubation, after which fiberoptic bronchoscopy was performed. The accuracy of bedside real-time tracheal ultrasonography in determining the ETT position was examined. Results Twelve (10.2%) patients underwent endotracheal intubation. The kappa value was 0.844, indicating perfect consistency between tracheal ultrasonography and fiberoptic bronchoscopy in identifying esophageal intubation. The sensitivity, specificity, and positive and negative predictive values of tracheal ultrasonography in determining the ETT position were 75.0%, 100%, 100%, and 97.2%, respectively. Conclusions Bedside real-time tracheal ultrasonography accurately assesses the ETT position in the ICU and can identify the ETT position during intubation. These findings have important clinical applications and are of great significance for treatment of ICU patients.

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Emergency Physician–Verified Out-of-hospital Intubation: Miss Rates by Paramedics

Cited by 20 publications

References 11 publications

Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

Where's the Tube? Evaluation of Hand-held Ultrasound in Confirming Endotracheal Tube Placement

4

Application of bedside real-time tracheal ultrasonography for confirmation of emergency endotracheal intubation in patients in the intensive care unit

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