Abstract
Background & Aims:
In paediatric patients, due to shorter trachea, suboptimal positioning of endotracheal tube (ETT) is seen in 20-50% of patients triggering grave complications. We compared standard auscultation and ultrasound-guided lung sliding to confirmposition of ETT in children.
Methods:
75 paediatric patients between 2-8 years of age, American Society of Anesthesiologists (ASA) I and II scheduled for surgery under general anaesthesia with endotracheal intubation were studied. Position of ETT was confirmed by chest auscultation for the breath sounds bilaterally and by ultrasound on same sites for lung-sliding sign. The data obtained were compared to findings on waveform capnography. Study outcomes included position of the ETT; tracheal or oesophageal, accuracy and time taken till confirmingthe diagnosis.
Results:
Compared to waveform capnography findings, ultrasound revealed sensitivity of 100% and specificity of 41.7% while that for standard auscultation were 72.86% and 100% respectively. The mean time taken for confirmation of ETT position by auscultation was 32.38±6.2s and was significantly lower (p=0.001s) than the ultrasonography time of 136.8±7s. However, ultrasonography findings were 90.7% accurate which was significantly higher than 74.7% accuracy of auscultation.
| VCV | PCV-VG | P | |||
|---|---|---|---|---|---|
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| Mean | SD | Mean | SD | ||
| % change in set parameter | |||||
| FiO2 | 1.65 | 4.29 | 0.09 | 8.46 | 0.607 |
| TV | 2.37 | 6.67 | 1.66 | 3.78 | 0.765 |
| RR | -1.27 | 8.79 | 0.41 | 5.03 | 0.304 |
| % change in measured parameter | |||||
| PIP | 20.10 | 10.67 | 18.05 | 17.16 | 0.607 |
| PlatP | 28.38 | 17.91 | 26.66 | 22.94 | 0.765 |
| VTe | -3.16 | 12.04 | -0.28 | 7.44 | 0.304 |
| Compl | -50.73 | 28.53 | -50.49 | 46.22 | 0.982 |
| R | 21.55 | 12.11 | 16.31 | 24.84 | 0.339 |
| EtCO2 | 1.19 | 9.42 | -3.64 | 8.16 | 0.054 |
| SpO2 | -0.04 | 0.20 | -0.04 | 0.20 | 0.983 |
Conclusion:
Confirmation of ETT position using ultrasonography or waveform capnography is essential because of high false results using standard auscultation alone. Ultrasound-guided lung sliding method is a simple and accurate method used for detectingtube malposition.
References
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