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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Validation of tracheal intubation of wire-reinforced endotracheal tube with ultrasonography


Objective. The use of ultrasonography (US) is a new method for verifying the location of the endotracheal tube.

Design. Our study was designed as a paired-data and investigator-blind clinical study for evaluating the effectiveness of US for verification of wire-reinforced endotracheal tube (WR-ETT) placement compared with capnography.

Setting. This study was conducted on 56 patients scheduled for elective surgery under general anesthesia.

Patients. Fifty patients completed the study as 6 were excluded for various reasons.

Intervention. Two different investigators performed the ultrasonography and intubation independently from one another. While investigator 1 attempted to verify the location of the WR-ETT with a portable ultrasonography with sagittal trans-tracheal view, investigator 2 intubated the patient and verified the location of the ETT using capnography.

Measurements. Time for verifying the location of the ETT using both US and capnography was recorded.

Main Results. When the ultrasonography method was compared with capnography for verification of the WR-ETT placement, the results showed 95.75% sensitivity and 100% specificity. The average verification times for endotracheal intubation were 12.78 ± 7.46 s. and 24.44 ± 1.45 s. with US and capnography, respectively (p=0.003).

Conclusion. Our results suggest that ultrasound identification of a WR-ETT within the trachea is a rapid and accurate method for confirmation of tracheal placement. Larger studies are needed before widespread use of this technique.

Key words: endotracheal tube, intubation, ultrasonography, capnography

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Clinical application of lung ultrasound in emergency department patients for the evaluation of pulmonary congestion: a comparison with chest X-ray


Introduction. Lung ultrasound can effectively rule out pulmonary edema when there is an absence of multiple B-lines and enables emergency physicians to improve their diagnostic performance, optimize therapeutic strategy, help early diagnosis for the patient and reduced hospital stay. The primary endpoint of this pilot study was to evaluate the effectiveness of lung ultrasound for diagnosing acute heart failure, even when used by emergency medicine residents, and assess the accuracy of B-line lung ultrasound in comparison to chest X-ray in emergency department patients.

Materials and methods. We enrolled 18 patients consecutively as they arrived at the Emergency Department of Clinical Hospital „Sveti Duh“, Croatia, presenting with undifferentiated acute dyspnea. Positive ultrasound confirmation of acute heart failure was defined as the bilateral existence of 2 or more positive regions with 3 or more B-lines.

Results. We found positive results regarding B-lines profile in 6 patients and cardiac decompensation was confirmed by their chest x-ray findings. The remaining 12 patients did not have B-lines by the LUS examination, neither signs of pulmonary congestion by their chest x-ray examination.

Conclusion. Lung ultrasound, given its practicability, simplicity and reproducibility, used by non-experts in emergency ultrasound, is a reliable tool for clinical examination of patients with acute heart failure.

Key words: emergency department, ultrasonography, heart failure, extravascular lung water

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Identification of lung sliding: a basic ultrasound technique with a steep learning curve


Introduction. One of the basic premises of sonographic lung imaging is the concept of lung sliding. Identification of clear lung sliding excludes pneumothorax (PTx) at that specific local point.
Methods. Fifty-seven 4th year medical students were given a 20-minute lecture on sonographic identification of lung sliding and exclusion of PTx. After the lecture, students were asked to correctly position the probe, identify shown structures and on each attempt (six attempts in a row) state whether lung sliding is present or not.
Results. There were 57 students in the sample. Fifty students (87.7%) successfully positioned the probe (all 4 positions) for PTx identification. All but five students (91.2%) recognized the anatomic structures of the thorax. Mean number of correctly identified cases per student was 5.1 ± 1.1. In 292 (85.4%) cases, the answer was correct. In 298 (87.1%) cases, students were confident in the correct answer. Students who were confident in the right answer gave the right answer significantly more often when compared to others (90.3% vs. 52.3%, p < 0.001). Sensitivity of this method for 4th year medical students was 82.6% and its specificity was 87.9%. For correct identification of lung sliding in the sixth attempt, students on average needed 4.5 correct attempts.
Conclusion. Our study suggests that 4th year medical students with no prior experience in lung ultrasonography can easily acquire knowledge and skills needed to detect thoracic wall structures and identify lung sliding with a high degree of sensitivity and specificity.

Key words: medical students, ultrasonography, pneumothorax

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