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Title:Ultrazvočna ocena lege dihalne cevke v predbolnišničnem okolju
Authors:ID Zadel, Sabina (Author)
ID Mekiš, Dušan (Mentor) More about this mentor... New window
Files:.pdf DOK_Zadel_Topic_Sabina_2018.pdf (9,34 MB)
MD5: 4F4DAA3B41E5A2C9B79A99810336D98B
PID: 20.500.12556/dkum/cf4e2d65-7583-4c3b-979a-8bcd25af826c
 
Language:Slovenian
Work type:Doctoral dissertation
Organization:MF - Faculty of Medicine
Abstract:IZHODIŠČA Oskrba dihalne poti in predihavanje sta pri kritično bolnih, poškodovanih in bolnikih v srčnem zastoju nujna postopka, ki predstavljata izziv za vsakega zdravnika, ki ju izvaja. Zlati standard zaščite dihalne poti je vstavitev dihalne cevke v sapnik. Še posebej v predbolnišničnem okolju se s težavno oskrbo dihalne poti lahko sreča vsak, tudi zelo izkušen zdravnik, saj so možnosti uporabe različne opreme in zdravstvenega kadra omejene, pogoji v okolju pa nemalokrat manj ugodni. CILJI Cilj raziskave je bil raziskati uporabnost in diagnostično natančnost ultrazvočnega opazovanja plevralnega polzenja in premikanja trebušne prepone za potrditev pravilne lege dihalne cevke po urgentni vstavitvi dihalne cevke kritično bolnim, poškodovanim ali bolnikom v srčnem zastoju v predbolnišničnem okolju. METODE V predbolnišničnem okolju Prehospitalne enote Maribor smo v prospektivno raziskavo vključili polnoletne kritično bolne, poškodovane in bolnike v srčnem zastoju, ki so potrebovali oskrbo dihalne poti. Oceno lege dihalne cevke smo opravili z obojestransko avskultacijo dihalnih šumov in pretakanja zraka v želodcu ter z ultrazvočno metodo opazovanja plevralnega polzenja in premikanja trebušne prepone. Referenčna metoda za pravilno lego dihalne cevke je bila spektrografska kvantitativna kapnografija. REZULTATI Vključili smo 124 bolnikov. 111 bolnikom (89,5 %), ki smo jih vključili v raziskavo, je bila dihalna cevka v prvem poskusu vstavljena v dihalne poti. Pri 13 bolnikih (10,5 %), vključenih v raziskavo, je bilo treba zaradi lege dihalne cevke v požiralniku postopek vstavitve dihalne cevke ponoviti. Med 13 bolniki, ki so po prvem poskusu imeli dihalno cevko vstavljeno v požiralnik, je zdravnik pri 4 bolnikih napačno lego dihalne cevke prepoznal pred izvedbo kapnografije in ultrazvočne metode opazovanja plevralnega polzenja ter premikanja trebušne prepone. Pri ostalih 9 bolnikih, ki so sprva imeli vstavljeno cevko v požiralnik, je bila napačna lega dihalne cevke prepoznana s pomočjo nenormalnih izvidov kapnografije in ultrazvočne metode.Pri vseh bolnikih je bila dihalna cevka po drugem poskusu vstavitve vstavljena v dihalne poti. Senzitivnost in negativna napovedna vrednost avskultacije sta bili 100-odstotni, specifičnost 90-odstotna, pozitivna napovedna vrednost pa 30-odstotna (95-odstotni interval zaupanja). Ultrazvočno opazovanje plevralnega polzenja in premikanja trebušne prepone je imelo 100-odstotno senzitivnost, specifičnost, pozitivno napovedno vrednost in negativno napovedno vrednost (95-odstotni interval zaupanja). Senzitivnost, specifičnost, pozitivna napovedna vrednost in negativna napovedna vrednost za kombinacijo avskultacije in ultrazvočne metode so bile 100-odstotne. Pri 3 bolnikih smo z avskultacijo in ultrazvočno metodo ugotovili pregloboko vstavitev dihalne cevke v desno glavno sapnico, rezultati kapnografije pa so bili v vseh treh primerih normalni pred popravkom lege dihalne cevke in po njem. Za izvedbo ultrazvočne metode smo v povprečju potrebovali 30 sekund. ZAKLJUČKI S študijo smo dokazali odlično senzitivnost in specifičnost ocenjevanja lege dihalne cevke s pomočjo ultrazvočne metode opazovanja drsenja plever in premikanja trebušne prepone.Z ultrazvočno metodo opazovanja plevralnega polzenja in premikanja trebušne prepone smo v naši raziskavi kljub normalnim izvidom kapnografije našli pregloboko v desno glavno sapnico vstavljene dihalne cevke. Dokazali smo, da je čas za izvedbo ultrazvočne metode opazovanja plevralnega polzenja in premikanja trebušne prepone sprejemljiv. Z uporabo ultrazvočne metode najverjetneje skrajšamo čas, ki je potreben za prepoznavo nepravilne lege dihalne cevke, in tako izboljšamo verjetnost preživetja ter zmanjšamo posledice pri kritično bolnih, poškodovanih in bolnikih v srčnem zastoju.
Keywords:orotrahealna intubacija, predbolnišnično okolje, oskrba dihalne poti, kapnografija, ultrazvok, usmerjena ultrazvočna preiskava, plevralno polzenje, premikanje trebušne prepone
Place of publishing:Maribor
Year of publishing:2018
PID:20.500.12556/DKUM-68830 New window
COBISS.SI-ID:6318399 New window
NUK URN:URN:SI:UM:DK:EG6FIQUG
Publication date in DKUM:23.05.2018
Views:1454
Downloads:163
Metadata:XML DC-XML DC-RDF
Categories:MF
:
ZADEL, Sabina, 2018, Ultrazvočna ocena lege dihalne cevke v predbolnišničnem okolju [online]. Doctoral dissertation. Maribor. [Accessed 12 April 2025]. Retrieved from: https://dk.um.si/IzpisGradiva.php?lang=eng&id=68830
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Secondary language

Language:English
Title:Ultrasound method for orotracheal tube placement assessment in out-of-hospital setting
Abstract:BACKGRAOUND Airway management and ventilation of critical ill, traumatized and resuscitated patients is a challenge for every physician. Orotracheal intubation is still a golden standard. Because of limited equipment, limited number of medical team members and environment conditions in out-of-hospital setting a difficult airway management is even more likely. AIM The aim of our study was to assess the usefulness and accuracy of sonographic observation of lung sliding and diaphragm excursion for confirming of the proper tube position after an urgent orotracheal intubation in an out-of-hospital setting. METHODS Our single-centred prospective study included patients who needed out-of-hospital orotra- cheal intubation. After the intubation, bilateral chest auscultation and sonographic assessment of bilateral lung sliding and diaphragm excursion were done. Spectrographic quantitative capnography was used as the reference standard to confirm a proper tube position. RESULTS 124 patients were enrolled. In 111 patients (89,5%) the tube was inserted correctly in the first attempt of orotracheal intubation. Because the tube was put into oesophagus in the first attempt, 13 patients (10,5 %) had to be reintubated. 4 cases of misplaced tube position were recognized before capnography or ultrasound method were performed, the rest of the misplaced tubes (9 patients) were recognized with capnometry and ultrasound method. All tubes were placed correctly after the second attempt of orotracheal intubation. 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 ultrasound method alone and for a combination of auscultation and ultrasound method were 100% (95% confidence interval). In 3 patients, we detected endobronchial tube displacement with auscultation and ultrasound method. Capnography failed to detect displacement in all three cases. The median time needed for ultrasound method was 30 s. CONCLUSIONS The study revealed excellent sensitivity and specificity for orotracheal tube placement assessment with sonographic observation of lung sliding and diaphragm excursion. Though capnography failed to detect endobronchial tube displacement in three cases, studied ultrasound method succeeded to find them. The measured time needed to perform ultrasound method was acceptable short. Ultrasound method usage probably shortenes the time needed to recognize orotracheal tube misplacement into esophagus or endobronchial tube displacement, thus improving the likelihood of survival and minimizing the consequences in critically ill, traumatised and in resuscitated patients.
Keywords:Orotracheal intubation, Out-of-hospital setting, Prehospital setting, Airway management, Capnography, Point-of-Care-Ultrasound, Lung sliding, Diaphragm excursion


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