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Gonzalez JM, Ortega J, Gonzalez JE, Crenshaw N, McGhee S, Groom J. Point-of-Care Ultrasonography to Confirm Endotracheal Tube Placement: A Review for the Emergency Nurse Practitioner. Adv Emerg Nurs J 2024; 46:126-140. [PMID: 38736097 DOI: 10.1097/tme.0000000000000514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Ensuring correct placement of the endotracheal tube (ETT) during intubation is an important step to avoid complications. Appropriate placement of the ETT can be challenging and, if done incorrectly, can lead to complications such as hypoxemia, atelectasis, hyperinflation, barotrauma, cardiovascular instability, end organ damage, and even death. Although several procedures exist to help assess ETT confirmation, all have limitations, are not always reliable, and vary in their degree of accuracy. Point-of-care ultrasound (POCUS) has emerged as a useful tool in the emergency department for quick diagnosis and treatment of many emergency conditions (Gonzalez et al., 2020). The purpose of this paper is to describe a systematic approach for the emergency nurse practitioner to use POCUS to assess proper endotracheal placement and the positioning within the trachea based on prior studies that compare this modality to traditional ones.
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Affiliation(s)
- Juan M Gonzalez
- Author Affiliations: University of Miami School of Nursing and Health Studies, Coral Gables, Florida (Drs Gonzalez, Ortega, Gonzalez, Crenshaw, and Groom); and The Ohio State University The college of Nursing, Columbus, Ohio (Dr. McGhee)
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Zisblatt L, Moquin R, Ayres FGR, Dillman D, DiLorenzo AN, Grantham AE, MacEachern MP, Peoples EE, Chen F. Critical Appraisal of Anesthesiology Educational Research for 2020. THE JOURNAL OF EDUCATION IN PERIOPERATIVE MEDICINE : JEPM 2023; 25:E708. [PMID: 37720370 PMCID: PMC10502584 DOI: 10.46374/volxxv_issue3_chen] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Background This study reviews and appraises the articles published about anesthesiology education in 2020. The objective is to highlight high-quality evidence while showcasing articles with innovative ideas and high relevance to the practices of the anesthesiology education community. Methods Three Ovid MEDLINE databases, Embase.com, ERIC, PsycINFO, and PubMed were searched, followed by a manual review of articles published in the highest impact factor journals in both the fields of anesthesiology and medical education. Abstracts were double screened, and quantitative articles were subsequently scored by 3 randomly assigned raters. Qualitative studies were scored by 2 raters. Two different rubrics were used for scoring quantitative and qualitative studies. In addition, reviewers rated each article on its overall quality to create an additional list of top articles based solely on the opinion of the reviewers. Results A total of 2,491 citations were identified through the search criteria and the manual review. Of those, 61 articles met the inclusion criteria (57 quantitative and 4 qualitative). The top 12 quantitative papers and the top qualitative papers with the highest scores are reported and summarized. Conclusions We found that teaching clinical procedures continues to be a topic of interest, with more studies of improved rigor identified. New trends in wellness studies and increasing attention to distance learning and technology-assisted instructional methods were additional topics covered over the year.
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Affiliation(s)
- Lara Zisblatt
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Rachel Moquin
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fred Glenn-Roger Ayres
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Dawn Dillman
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Amy N DiLorenzo
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Ashley E Grantham
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mark P MacEachern
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Emily E Peoples
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fei Chen
- The following authors are at the University of Michigan, Ann Arbor, MI: is an Education Specialist in the Department of Anesthesiology; is a medical student; is an Assistant Professor and Residency Program Director in the Department of Anesthesiology; is an Informationist in the Taubman Health Sciences Library. is an Assistant Professor and Director of Learning and Development in the Department of Anesthesiology at Washington University School of Medicine in St. Louis, St. Louis, MO; is a Clinical Professor in the Department of Anesthesia at the University of Iowa Hospitals and Clinics, Iowa City, IA; is Assistant Dean of Graduate Medical Education and an Assistant Professor in the Department of Anesthesiology at the University of Kentucky Chandler Medical Center, Lexington, KY; is a Medical Education Specialist in the Department of Anesthesiology at Duke University School of Medicine, Durham, NC; is an Assistant Professor in the Department of Anesthesiology at the University of North Carolina at Chapel Hill, Chapel Hill, NC
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Reuter PG, Ballouz C, Loeb T, Petrovic T, Lapostolle F. Detecting cervical esophagus with ultrasound on healthy voluntaries: learning curve. Ultrasound J 2023; 15:20. [PMID: 37126203 PMCID: PMC10151284 DOI: 10.1186/s13089-023-00315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/12/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND The objective of this study was to determine the learning curve of tracheal-esophageal ultrasound by prehospital medical and paramedical staff. METHODS A single-center prospective study was carried out at a French EMS (SAMU 92). Volunteer participants first received a short theoretical training through e-learning, followed by two separate hands-on workshops on healthy volunteers, spaced one to two months apart. Learners were timed to obtain the tracheal-esophageal ultrasound target image 10 consecutive times. The first workshop was intended to perform a learning curve, and the second was to assess unlearning. The secondary objectives were to compare performance by profession and by previous ultrasound experience. RESULTS We included 32 participants with a mean age of 38 (± 10) years, consisting of 56% men. During the first workshop, the target image acquisition time was 20.4 [IQR: 10.6;41] seconds on the first try and 5.02 [3.72;7.5] seconds on the 10th (p < 0.0001). The image acquisition time during the second workshop was shorter compared to the first one (p = 0.016). In subgroup analyses, we found no significant difference between physicians and nurses (p = 0.055 at the first workshop and p = 0.164 at the second) or according to previous ultrasound experience (p = 0.054 at the first workshop and p = 0.176), counter to multivariate analysis (p = 0.02). CONCLUSIONS A short web-based learning completed by a hands-on workshop made it possible to obtain the ultrasound image in less than 10 s, regardless of the profession or previous experience in ultrasound.
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Affiliation(s)
- Paul-Georges Reuter
- Service des Urgences, SAMU, SMUR, CHU Pontchaillou, Université Rennes, Rennes, France.
- Équipe Soins Primaires et Prévention, Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, CESP, 94807, Villejuif, France.
| | - Chris Ballouz
- Samu des Hauts-de-Seine, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Thomas Loeb
- Samu des Hauts-de-Seine, Assistance Publique-Hôpitaux de Paris, Hôpital Raymond Poincaré, 92380, Garches, France
| | - Tomislav Petrovic
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, 125, Rue de Stalingrad, 93009, Bobigny, France
| | - Frédéric Lapostolle
- SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, 125, Rue de Stalingrad, 93009, Bobigny, France
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Lin J, Bellinger R, Shedd A, Wolfshohl J, Walker J, Healy J, Taylor J, Chao K, Yen YH, Tzeng CFT, Chou EH. Point-of-Care Ultrasound in Airway Evaluation and Management: A Comprehensive Review. Diagnostics (Basel) 2023; 13:diagnostics13091541. [PMID: 37174933 PMCID: PMC10177245 DOI: 10.3390/diagnostics13091541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term "ultrasound" combined with several search terms, i.e., "probe", "anatomy", "difficult airway", "endotracheal intubation", "laryngeal edema", and "cricothyrotomy" was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting.
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Affiliation(s)
- Judy Lin
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Ryan Bellinger
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
| | - Andrew Shedd
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jon Wolfshohl
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jennifer Walker
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jack Healy
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Jimmy Taylor
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Kevin Chao
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
| | - Yi-Hsuan Yen
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Ching-Fang Tiffany Tzeng
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX 75246, USA
| | - Eric H Chou
- Department of Emergency Medicine, Baylor Scott & White All Saints Medical Center, Fort Worth, TX 76104, USA
- Burnett School of Medicine, Texas Christian University, Fort Worth, TX 76109, USA
- Department of Emergency Medicine, Baylor University Medical Center, Dallas, TX 75246, USA
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Lombardi A, De Luca M, Fabiani D, Sabatella F, Del Giudice C, Caputo A, Cante L, Gambardella M, Palermi S, Tavarozzi R, Russo V, D’Andrea A. Ultrasound during the COVID-19 Pandemic: A Global Approach. J Clin Med 2023; 12:jcm12031057. [PMID: 36769702 PMCID: PMC9918296 DOI: 10.3390/jcm12031057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
SARS-CoV-2 (severe acute respiratory syndrome Coronavirus-2) rapidly spread worldwide as COVID-19 (Coronavirus disease 2019), causing a costly and deadly pandemic. Different pulmonary manifestations represent this syndrome's most common clinical manifestations, together with the cardiovascular complications frequently observed in these patients. Ultrasound (US) evaluations of the lungs, heart, and lower limbs may be helpful in the diagnosis, follow-up, and prognosis of patients with COVID-19. Moreover, POCUS (point-of-care ultrasound) protocols are particularly useful for patients admitted to intensive care units. The present review aimed to highlight the clinical conditions during the SARS-CoV-2 pandemic in which the US represents a crucial diagnostic tool.
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Affiliation(s)
- Anna Lombardi
- Department of General Medicine, San Leonardo Hospital, 80053 Castellammare di Stabia, Italy
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Dario Fabiani
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Francesco Sabatella
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Carmen Del Giudice
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Adriano Caputo
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Luigi Cante
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Michele Gambardella
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Rita Tavarozzi
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, 28100 Novara, Italy
| | - Vincenzo Russo
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Luigi Vanvitelli University–Monaldi Hospital, 80131 Naples, Italy
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
- Correspondence:
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Roy PS, Joshi N, Garg M, Meena R, Bhati S. Comparison of ultrasonography, clinical method and capnography for detecting correct endotracheal tube placement- A prospective, observational study. Indian J Anaesth 2022; 66:826-831. [PMID: 36654895 PMCID: PMC9842085 DOI: 10.4103/ija.ija_240_22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/17/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Background and Aims In emergency airway management, unstable haemodynamics of the patients calls for the early need to detect correct endotracheal tube (ETT) placement. Ultrasonography has an advantage of being readily available along with being non-invasive and providing real time images. We aimed to study the usefulness of tracheal ultrasonography and use it as a tool to assess correct tracheal intubation in patients in the intensive care unit. Methods This was a hospital-based observational study. The study included 92 patients who needed and were taken up for endotracheal intubation. Tube placement was confirmed simultaneously by three different observers with their respective method, i.e., ultrasonography, clinical method and capnography. Results Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of ultrasonography against capnography were 100% each with P value of 1. However, for clinical method against capnography, the sensitivity was 96.5%, specificity 28.6%, PPV 94.3% and NPV 40% with P value of 0.727. Mean time taken to detect correct placement of the ETT by ultrasonography, capnography and clinical method was 4.93 s, 15.39s and 17.80s, respectively. Out of 92 intubations, 85 were tracheal and 7 were oesophageal. All intubations were detected accurately with ultrasonography and capnography, ultrasonography being faster. Clinical method correctly detected 82 out of 85 tracheal intubations and 2 out of 7 oesophageal intubations, and was therefore less accurate than the other two methods. Conclusion The study shows that ultrasonography is as reliable a method for confirmation of endotracheal intubation as capnography and is more reliable than clinical method. Besides, ultrasonography is faster than the other two methods.
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Affiliation(s)
- Purbali S. Roy
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Nandkishore Joshi
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Monika Garg
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
| | - Reema Meena
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India,Address for correspondence: Dr. Reema Meena, Department of Anaesthesia, SMS Medical College, Jaipur, Rajasthan 302 004, India. E-mail:
| | - Sushil Bhati
- Department of Anaesthesiology, Sawai Man Singh Medical College, Jaipur, Rajasthan, India
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7
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Ariff S, Ali KQ, Tessaro MO, Ansari U, Morris S, Soofi SB, Merali HS. Diagnostic accuracy of point-of-care ultrasound compared to standard-of-care methods for endotracheal tube placement in neonates. Pediatr Pulmonol 2022; 57:1744-1750. [PMID: 35501297 DOI: 10.1002/ppul.25955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/07/2022] [Accepted: 04/25/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Point-of-care ultrasound (POCUS) is a valuable tool to determine endotracheal tube (ETT) placement; however, few studies have compared it with standard confirmation methods. We evaluated the diagnostic accuracy of POCUS and time-to-interpretation for correct identification of tracheal versus esophageal intubations compared to a composite of standard-of-care methods in neonates. METHODS A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi, Pakistan. All required intubations were performed as per NICU guidelines. The clinical team simultaneously determined the ETT placement using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by POCUS. In addition, the clinical team was blinded to the POCUS images. Timings were recorded for each method by independent study staff. RESULTS A total of 348 neonates were enrolled in the study. More than half (58%) of intubations were in an emergency scenario. POCUS user interpretation showed 100% sensitivity and 94% specificity using an expert as the reference standard. We found a 99.4% agreement (Kappa: 0.96; p < 0.001). Diagnostic accuracy of POCUS compared with at least two standard-of-care methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9% agreement (Kappa:0.93; p < 0.001). The median time required for POCUS interpretation was 3.0 (interquartile range [IQR] 3.0-4.0) seconds for tracheal intubation. The time recorded for auscultation and capnography was 6.0 (IQR 5.0-7.0) and 3.0 (IQR 3.0-4.0), respectively. CONCLUSION POCUS is a rapid and reliable method of identifying ETT placement in neonates. Early and correct identification of airway management is critical to save lives and prevent mortality and morbidity.
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Affiliation(s)
- Shabina Ariff
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Khushboo Q Ali
- Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Mark O Tessaro
- Pediatric Emergency Medicine, Emergency Point-of-Care Ultrasound Program, The Hospital for Sick Children, Toronto, Canada
| | - Uzair Ansari
- Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Shaun Morris
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Sajid Bashir Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan.,Center of Excellence for Women & Child Health, Aga Khan University, Karachi, Pakistan
| | - Hasan S Merali
- Pediatric Emergency Medicine, McMaster Children's Hospital, Hamilton, Canada
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8
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White-Dzuro GA, Gibson LE, Berra L, Bittner EA, Chang MG. Portable Handheld Point-of-Care Ultrasound for Detecting Unrecognized Esophageal Intubations. Respir Care 2022; 67:607-612. [PMID: 35473838 PMCID: PMC9994246 DOI: 10.4187/respcare.09239] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Esophageal intubations are not an uncommon occurrence in prehospital settings, occurring as high as 17%. These "never events" are associated with significant morbidity and mortality especially when unrecognized or when there is delayed recognition. Here, we review the currently available techniques for confirming endotracheal tube intubation and their limitations, and present the case for the application of portable handheld point-of-care ultrasound as an emerging technology for detection of potentially unrecognized esophageal intubations such as during cardiac arrest. We also provide algorithms for confirmation of tracheal intubation.
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Affiliation(s)
- Gabrielle A White-Dzuro
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lauren E Gibson
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Lorenzo Berra
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Edward A Bittner
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Marvin G Chang
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Leviter J, Auerbach M, Amick M, O'Marr J, Battipaglia T, Amendola C, Riera A. Point-of-Care Ultrasound Curriculum for Endotracheal Tube Confirmation for Pediatric Critical Care Transport Team Through Remote Learning and Teleguidance. Air Med J 2022; 41:222-227. [PMID: 35307147 DOI: 10.1016/j.amj.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/30/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) is used to manage patients in real time. This study aimed to teach pediatric critical care team members to use POCUS for endotracheal tube (ETT) placement confirmation. A secondary aim was to assess the feasibility of a remote curriculum for this purpose. METHODS The Kern 6-step approach was used. The curriculum involved virtual didactics, asynchronous learning modules, and remote hands-on sessions using teleguidance with the Butterfly IQ+ probe, Butterfly Network, Inc, Guilford, CT. Participants learned direct and indirect methods of ETT placement confirmation and were directed to practice independently. Outcomes included attitudes and satisfaction, knowledge and skills acquisition and retention, and the use of POCUS on shift. RESULTS Ten participants completed the curriculum. The average knobology and quiz scores improved by 29.3% and 20.8%, respectively. Improvement was sustained at re-evaluation. Seven of 10 participants performed independent scans. At the 3-month reassessment, most demonstrated mastery of thoracic scans. All required prompting for satisfactory tracheal scans. All felt positively toward POCUS and the remote curriculum. CONCLUSION Pediatric critical care team members acquired and retained knowledge and skills for POCUS basics and ETT placement confirmation through a remote curriculum. Participants were satisfied with the course. Further studies are needed to reassess longer-term knowledge and skill retention and the effects on patient outcomes.
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Affiliation(s)
- Julie Leviter
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
| | - Marc Auerbach
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT; Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT.
| | | | | | - Tracie Battipaglia
- Yale Pediatric Critical Care Transport Team, Yale New Haven Children's Hospital, New Haven, CT.
| | - Christopher Amendola
- Yale Pediatric Critical Care Transport Team, Yale New Haven Children's Hospital, New Haven, CT.
| | - Antonio Riera
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
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Farrokhi M, Yarmohammadi B, Mangouri A, Hekmatnia Y, Bahramvand Y, Kiani M, Nasrollahi E, Nazari-Sabet M, Manoochehri-Arash N, Khurshid M, Mosalanejad S, Hajizadeh V, Amani-Beni R, Moallem M, Farahmandsadr M. Screening Performance Characteristics of Ultrasonography in Confirmation of Endotracheal Intubation; a Systematic Review and Meta-analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e68. [PMID: 34870234 PMCID: PMC8628646 DOI: 10.22037/aaem.v9i1.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Recent studies have suggested that point-of-care ultrasonography can be used for confirming the placement of endotracheal tube. This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of ultrasonography for confirming endotracheal tube placement. Methods: In this meta-analysis, systematic search of the previous published papers investigating the diagnostic accuracy of ultrasonography for confirmation of endotracheal tube placement was performed. Seven electronic databases, including PubMed, Scopus, Google Scholar, EBSCO, EMBASE, Web of Science, and Cochrane Database were searched up to July 2021, for all relevant articles published in English on this topic. Meta-DiSc version 1.4 software was used for statistical analysis. Results: The estimated pooled sensitivity and specificity of ultrasonography for confirmation of endotracheal tube location were 0.98 (95% CI: 0.98–0.99) and 0.94 (95% CI 0.91–0.96), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 5.94 (95% CI 4.41–7.98) and 0.03 (95% CI: 0.02-0.04), respectively. The diagnostic odds ratio of ultrasonography was 281.47 and the area under hierarchical summary receiver operating characteristic (HSROC) revealed an appropriate accuracy of 0.98. Conclusion: Ultrasonography has high diagnostic accuracy and can be used as a promising tool for confirmation of endotracheal tube placement, especially in critically ill patients or when capnography is not available, or its result is equivocal.
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Affiliation(s)
| | - Bardia Yarmohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Mangouri
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Hekmatnia
- Islamic Azad University, Sari Branch, School of Medicine, Sari, Iran
| | - Yaser Bahramvand
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moein Kiani
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elham Nasrollahi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Nazari-Sabet
- Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niusha Manoochehri-Arash
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maria Khurshid
- Department of Internal Medicine, Berkshire Medical Center, Pittsfield, Massachusetts, USA
| | - Shima Mosalanejad
- Department of Internal Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Vida Hajizadeh
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Moallem
- Department of Emergency Medicine, School of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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[Focused ultrasound in the emergency room]. Med Klin Intensivmed Notfmed 2021; 116:390-399. [PMID: 33420555 DOI: 10.1007/s00063-020-00768-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
Ultrasound is an important tool in diagnosis and treatment of critically ill patients. For trauma patients the eFAST (extended focused assessment with sonography for trauma) algorithm is already implemented in the diagnostic pathway. However, critically ill patients without trauma also need a structured approach including an early focused ultrasonographic exam. National and international guidelines regarding critical illnesses such as acute coronary syndrome, cardiogenic shock complicating myocardial infarction, pulmonary embolism or acute aortic syndromes recommend the use of ultrasound. We present pathways how ultrasound can be used in the diagnostic approach of common symptoms such as dyspnea, shock and abdominal pain. Using the ABCDE approach this article shows how ultrasound can be incorporated into the diagnostic pathway.
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Wang Y, Wei HF, Ma WH. Endotracheal intubation confirmation in COVID-19 patients. Minerva Anestesiol 2020; 87:116-117. [PMID: 33231412 DOI: 10.23736/s0375-9393.20.15228-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Yong Wang
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China -
| | - Hua-Feng Wei
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Wu-Hua Ma
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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