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Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting.
Resuscitation. 2015 Feb; 87:1-6.R

Abstract

AIM OF THE STUDY

The percentage of unrecognised orotracheal tube displacement in an out-of-hospital setting has been reported to be between 4.8% and 25%. The aim of our study was to assess the sensitivity and specificity of Point-of-Care-UltraSound (POCUS) for confirming the proper tube position after an urgent orotracheal intubation in an out-of-hospital setting and the time needed for POCUS.

METHODS

Our single-centred prospective study included all patients who needed out-of-hospital orotracheal intubation. After the intubation, bilateral chest auscultation and assessment of bilateral lung sliding and diaphragm excursion within POCUS were done. Spectrographic quantitative capnography was used as the reference standard to confirm a proper tube position.

RESULTS

We enrolled 124 patients. For auscultation, sensitivity and negative predicted value were 100%, specificity was 90% and positive predicted value 30% (95% confidence interval). Sensitivity, specificity, positive predicted value, and negative predicted value for POCUS alone and for a combination of auscultation and POCUS were 100% (95% confidence interval). In three patients, we detected endobronchial tube displacement with auscultation and POCUS. Capnography failed to detect displacement in all three cases. The median time needed for POCUS was 30s.

CONCLUSION

Results of our study support POCUS as an accurate and reliable method for confirming the proper orotracheal tube placement in trachea and it is feasible for out-of-hospital setting implementation. POCUS also seems to be time saving method but to make definitive conclusion more studies should be done.

Authors+Show Affiliations

Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia.Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia; Department of Emergency Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia.Center for Emergency Medicine, Community Health Centre Maribor, Proletarskih brigad 22, 2000 Maribor, Slovenia; Department of Physiology, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia; Department of Emergency Medicine, Faculty of Health Sciences, University of Maribor, Žitna 15, 2000 Maribor, Slovenia.Department of Emergency Medicine, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia; Department of Anaesthesiology, Intensive Care and Pain Management, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia; Department of Anaesthesiology and Reanimation, Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia. Electronic address: dusan.mekis@ukc-mb.si.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25450569

Citation

Zadel, Sabina, et al. "Point of Care Ultrasound for Orotracheal Tube Placement Assessment in Out-of Hospital Setting." Resuscitation, vol. 87, 2015, pp. 1-6.
Zadel S, Strnad M, Prosen G, et al. Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation. 2015;87:1-6.
Zadel, S., Strnad, M., Prosen, G., & Mekiš, D. (2015). Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. Resuscitation, 87, 1-6. https://doi.org/10.1016/j.resuscitation.2014.11.006
Zadel S, et al. Point of Care Ultrasound for Orotracheal Tube Placement Assessment in Out-of Hospital Setting. Resuscitation. 2015;87:1-6. PubMed PMID: 25450569.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting. AU - Zadel,Sabina, AU - Strnad,Matej, AU - Prosen,Gregor, AU - Mekiš,Dušan, Y1 - 2014/11/20/ PY - 2014/06/27/received PY - 2014/11/05/revised PY - 2014/11/06/accepted PY - 2014/12/3/entrez PY - 2014/12/3/pubmed PY - 2015/12/30/medline KW - Airway management KW - Capnography KW - Orotracheal intubation KW - Out-of-hospital setting KW - Point-of-Care-Ultrasound KW - Prehospital setting SP - 1 EP - 6 JF - Resuscitation JO - Resuscitation VL - 87 N2 - AIM OF THE STUDY: The percentage of unrecognised orotracheal tube displacement in an out-of-hospital setting has been reported to be between 4.8% and 25%. The aim of our study was to assess the sensitivity and specificity of Point-of-Care-UltraSound (POCUS) for confirming the proper tube position after an urgent orotracheal intubation in an out-of-hospital setting and the time needed for POCUS. METHODS: Our single-centred prospective study included all patients who needed out-of-hospital orotracheal intubation. After the intubation, bilateral chest auscultation and assessment of bilateral lung sliding and diaphragm excursion within POCUS were done. Spectrographic quantitative capnography was used as the reference standard to confirm a proper tube position. RESULTS: We enrolled 124 patients. For auscultation, sensitivity and negative predicted value were 100%, specificity was 90% and positive predicted value 30% (95% confidence interval). Sensitivity, specificity, positive predicted value, and negative predicted value for POCUS alone and for a combination of auscultation and POCUS were 100% (95% confidence interval). In three patients, we detected endobronchial tube displacement with auscultation and POCUS. Capnography failed to detect displacement in all three cases. The median time needed for POCUS was 30s. CONCLUSION: Results of our study support POCUS as an accurate and reliable method for confirming the proper orotracheal tube placement in trachea and it is feasible for out-of-hospital setting implementation. POCUS also seems to be time saving method but to make definitive conclusion more studies should be done. SN - 1873-1570 UR - https://www.unboundmedicine.com/medline/citation/25450569/Point_of_care_ultrasound_for_orotracheal_tube_placement_assessment_in_out_of_hospital_setting_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0300-9572(14)00815-6 DB - PRIME DP - Unbound Medicine ER -