超声在麻醉科的应用讲述.pptx

Auscultation versus Point-of-care Ultrasound toDetermine Endotracheal versus Bronchial Intubation Di Zhang Do You Believe What You See or What You Hear? Background Unrecognized malposition of the endotracheal tube (ETT) can lead to severe complications in patients under general anesthesia. The focus of this double-blinded randomized study was to assess the accuracy of point-of-care ultrasound in verifying the correct position of the ETT and to compare it with the accuracy of auscultation. Overview Endobronchial intubation is the most common malposition encountered,and it carries potential serious complications such as hypoxemia, atelectasis, hyperinflation, and barotrauma and can lead to pulmonary infection if not diagnosed early. Auscultation has been the standard for determining ETT location and is recommended by institutions such as the American Heart Association, as well as major Anesthesiology and Perioperative Care text books. However, the use of auscultation to distinguish between tracheal and bronchial intubation has been shown to be unreliable, with a reported sensitivity of only 60 to 65%. Ultrasound is quick and inexpensive, and with the recent development of handheld ultrasound device, it is already readily available in the clinical areas where endotracheal intubation occurs. Recent evidence has supported the use of point-of-care ultrasound for the detection of esophageal versus tracheal intubations with reported sensitivity/ specificity of 100% for adult patients in the operating room. In fact, the 2015 American Heart Association Guidelines Update for Cardiopulmonary resuscitation and Emergency Cardiovascular Care recommend the use of ultrasound as an adjunct tool to confirm correct tube position when carbon dioxide monitoring is not available. Methods Forty-two adult patients requiring general anesthesia with ETT were consented. Patients were randomized to right main bronchus, left main bronchus, or tracheal intubation. A