scholarly journals Ultrasonography for Endotracheal Tube Placement Confirmation in an Emergency Setting - A Prospective Study in a Teritiary Hospital

2018 ◽  
Vol 5 (2) ◽  
pp. 3545-3549
Author(s):  
Dr. A.Srikanth Reddy ◽  
Dr.Inugala Raj Kumar Reddy ◽  
Dr.Polupangu Hima Bindu
Keyword(s):  
Endotracheal Tube ◽  
Sensitivity And Specificity ◽  
Tertiary Care ◽  
High Sensitivity ◽  
Tube Placement ◽  
Emergency Setting ◽  
Care Hospital ◽  
Clinical Method ◽  
Clinical Methods ◽  
Endotracheal Tube Placement

Background: Ultrasonography, clinical methods and capnography are used to confirm the proper placement of endotracheal tube. Ultrasonography was thought to have high sensitivity and specificity and took less when compared with other two methods. Aims: To compare ultrasonography with the traditional clinical methods and the gold standard quantitative waveform capnography in confirming the proper placement of endotracheal tube. Materials and Methods: We carried out a prospective cohort study on 120 patients who were indicated for intubation in an emergency department of a tertiary care hospital, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, Telangana State, India. The study was carried out from June 2017 to December 2017. The confirmation of endotracheal tube placement was identified by three methods, ultrasonography, quantitative waveform capnography (end-tidal carbon dioxide) and traditional clinical method. The parameters recorded by three methods were confirmation of tube placement and time taken for tube placement. Results: Out of the 120 intubation attempts, six (5 %) had esophageal intubations. Ultrasonography produced a sensitivity and specificity of diagnosis of 98.63% and 100%, respectively, which was statistically comparable with the other two methods. When the time taken to confirm tube placement was compared, it was found that ultrasonography took significantly less time. The time taken by ultrasonography, waveform capnography and clinical methods was 8.13 ± 1.27, 17.86 ± 2.34 and 20.13 ± 2.72 seconds respectively. Conclusion: The endotracheal tube placement was confirmed by ultrasonography with comparable sensitivity and specificity to other two methods i.e. quantitative waveform capnography and clinical methods and it took less time.

scholarly journals Reliability of ultrasonography in confirming endotracheal tube placement in an emergency setting

2017 ◽  
Vol 21 (5) ◽  
pp. 257-261 ◽  
Author(s):  
Vimal Koshy Thomas ◽  
Cherish Paul ◽  
Punchalil Chathappan Rajeev ◽  
Babu Urumese Palatty
Keyword(s):  
Endotracheal Tube ◽  
Tube Placement ◽  
Emergency Setting ◽  
Endotracheal Tube Placement

Explicit Diagnostic Criteria for Transient Ischemic Attacks Used in the Emergency Department Are Highly Sensitive and Specific

2020 ◽  
pp. 1-6
Author(s):  
Carl H. Göbel ◽  
Sarah C. Karstedt ◽  
Thomas F. Münte ◽  
Hartmut Göbel ◽  
Sebastian Wolfrum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Criteria ◽  
Sensitivity And Specificity ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Tertiary Care ◽  
High Sensitivity ◽  
University Hospital ◽  
Care Hospital ◽  
Transient Ischemic Attacks

<b><i>Background:</i></b> Making a correct diagnosis of a transient ischemic attack (TIA) is prone to errors because numerous TIA mimics exist and there is a shortage of evidence-based diagnostic criteria for TIAs. In this study, we applied for the first time the recently proposed explicit diagnostic criteria for transient ischemic attacks (EDCT) to a group of patients presenting to the emergency department of a large German tertiary care hospital with a suspected TIA. The aim was to determine the sensitivity and specificity of the EDCT in its clinical application. <b><i>Methods:</i></b> A total of 128 patients consecutively presenting to the emergency department of the University Hospital of Lübeck, Germany, under the suspicion of a TIA were prospectively interviewed about their clinical symptoms at the time of presentation. The diagnosis resulting from applying the EDCT was compared to the diagnosis made independently by the senior physicians performing the usual diagnostic work-up (“gold standard”), allowing calculation of sensitivity and specificity of the EDCT. <b><i>Results:</i></b> EDCT achieved a sensitivity of 96% and a specificity of 88%. When adding the additional criterion F (“the symptoms may not be better explained by another medical or mental disorder”), specificity significantly increased to 98%. <b><i>Conclusions:</i></b> The data show that the EDCT in its modified version as proposed by us are a highly useful tool for clinicians. They display a high sensitivity and specificity to accurately diagnose TIAs in patients referred to the emergency department with a suspected TIA.

scholarly journals Accuracy of 7-8-9 Rule for Endotracheal Tube Placement in Nepalese Neonates

2011 ◽  
Vol 31 (3) ◽  
pp. 175-179
Author(s):  
KP Paudel ◽  
D Nepal ◽  
C Mahaseth
Keyword(s):  
Endotracheal Tube ◽  
Tube Placement ◽  
Clinical Method ◽  
Children's Hospital ◽  
Gestation Age ◽  
Endotracheal Tube Placement ◽  
Children’S Hospital ◽  
Clinical Accuracy ◽  
Chest X Ray ◽  
G 12

Introduction: Neonatal intubation is done for cardiopulmonary resuscitation, hypoxemia, and hypercapnia, for surfactant therapy or for airway protection. When correctly placed, endotracheal tube (ETT) tip should be at mid tracheal position which is half way between the clavicles and the carina to prevent complications of ventilation. Objective: To assess the accuracy of 7-8-9 Rule in neonates at Kanti Children’s hospital. Methodology: Prospective observational study was conducted in neonates who required oral intubations from July 2009 to December 2009 at NICU of Kanti Children’s Hospital. The initial ETT depth of insertion was determined using admission weight in the 7-8-9 Rule calculation. This depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. Results: Mean gestation age of the 69 infants was 36.01 weeks (26 to 42 weeks) and weight was 2411 g( 900 g to 3800 g ). 7 (10.1%) neonates weighed 1000 g or less, 19 (27.5%) weighed between 1001 to 2000 g, 31 ( 44.9%) weighed between 2001 to 3000 g, 12(17.4%) weighed between 3001 to 4000 g. The accuracy of 7-8-9 rule in clinical setting with auscultation and Chest x-ray resulted in ETT depth 0.11 cm above midtracheal position. (-1.5 to 1.5 cm). Using this rule ET tube was placed 0.11 cm above the mid tracheal position. Conclusions: The 7-8-9 Rule appears to be an accurate clinical method for endotracheal tube placement in Nepalese neonates. Keywords: Intubation; Neonate; Mid Tracheal Position DOI: http://dx.doi.org/10.3126/jnps.v31i3.4299 J Nep Paedtr Soc 2011;31(3): 175-179

The Sensitivity and Specificity of Transcricothyroid Ultrasonography to Confirm Endotracheal Tube Placement in a Cadaver Model

2007 ◽  
Vol 32 (4) ◽  
pp. 405-407 ◽  
Author(s):  
Gene Ma ◽  
Daniel P. Davis ◽  
James Schmitt ◽  
Gary M. Vilke ◽  
Theodore C. Chan ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Sensitivity And Specificity ◽  
Tube Placement ◽  
Endotracheal Tube Placement

scholarly journals Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

2021 ◽  
Author(s):  
Ashoka Mahapatra ◽  
K Nikitha ◽  
Sutapa Rath ◽  
Bijayini Behera ◽  
Kavita Gupta
Keyword(s):  
Tertiary Care ◽  
High Sensitivity ◽  
Care Hospital ◽  
Predictive Values ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Rectal Swabs ◽  
Control And Prevention ◽  
Indian Setting ◽  
Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

Comparison of a Colorimetric End-Tidal CO2 Detector and an Esophageal Aspiration Device for Verifying Endotracheal Tube Placement in the Prehospital Setting: A Six-Month Experience

1997 ◽  
Vol 12 (1) ◽  
pp. 57-63 ◽  
Author(s):  
Richard J. Schaller ◽  
J. Stephen Huff ◽  
Allan Zahn
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Tube ◽  
Sensitivity And Specificity ◽  
Nasotracheal Intubation ◽  
Prehospital Setting ◽  
Tube Placement ◽  
Emergency Department Physician ◽  
Significant Difference ◽  
End Tidal ◽  
Chi Square Analysis

AbstractIntroduction:Hand held, colorimetric, end-tidal CO2 detector devices are being used to verify correct endotracheal tube (ETT) placement. The accuracy of these devices has been questioned in situations of cardiac arrest. The use of the esophageal detector device (EDD) is an easy alternative for detection of ETT placement, and may be more accurate in situations of cardiac arrest.Hypothesis:The use of the esophageal aspiration device in comparison with a colorimetric end-tidal CO2 detector is more accurate in detecting proper ETT placement and easier to use in the prehospital setting than is the colorimetric end-tidal CO2 detection device.Methods:This was a prospective alternating weeks, 6-month study in a prehospital setting. Participants included all patients older than 18 years who were intubated by the Portsmouth, Virginia Emergency Medical Services (EMS) personnel from 01 July 1993 through 31 December 1993. The aspiration device used, also known as an esophageal detector device (EDD), was a 60 ml, luer-lock syringe attached to a 15 mm ETT adapter. Its efficacy was compared with an already accepted method of ETT position detection, the colorimetric endtidal CO2 detector. Each device was used on alternating weeks, and correct ETT placement was determined by the receiving emergency department physician using standard techniques. Chi-square analysis and Fisher's Exact test were used to compare parameters, time of device use, and ease of use. Sensitivity and specificity were calculated, and provider preference was assessed using a survey instrument administered following completion of the study.Results:There were 49 patients who met the inclusion criteria, but six were excluded because of situational circumstances rendering use of the device a possible compromise of patient care. Twenty-five patients were in the EDD group, and 18 were in the endtidal CO2 detector group. There was no statistically significant difference detected between groups for the gender ratio, underlying condition, CPR in progress, perceived difficulty of intubation, or percentage of nasotracheal intubation. The EDD was significantly easier to use (p<0.005). There was no statistically significant difference in time required for use of end-tidal CO2 detector device versus the EDD. The sensitivity and specificity for correct tracheal placement using the EDD was 100%, and the sensitivity for correct tracheal placement using the end-tidal CO2 detector device was 78%. Use of the EDD was preferred over use of the end-tidal CO2 detector device by 75% of participating EMS providers. One case of nasotracheal intubation with an ETT placement above the cords raised the question of accuracy of this device in situations where direct visualization is not utilized.Conclusion:The EDD was accurate in all cases of orotracheal intubation, and was easier to use than was end-tidal CO2 detector device. It was preferred by 75% of participating EMS providers. In cases in which the ETT may be above the vocal cords, caution must be used with interpreting the results obtained by use of the EDD.

Assessment of gas flow waves for endotracheal tube placement in an ovine model of neonatal resuscitation

Resuscitation ◽  
2010 ◽  
Vol 81 (6) ◽  
pp. 737-741 ◽  
Author(s):  
G.M. Schmölzer ◽  
S.B. Hooper ◽  
K.J. Crossley ◽  
B.J. Allison ◽  
C.J. Morley ◽  
...  
Keyword(s):  
Endotracheal Tube ◽  
Gas Flow ◽  
Neonatal Resuscitation ◽  
Tube Placement ◽  
Ovine Model ◽  
Endotracheal Tube Placement

THE SENSITIVITY, SPECIFICITY AND ACCURACY OF STATIC METHOD OF ULTRASONOGRAPHY TO CONFIRM ENDOTRACHEAL INTUBATION IN EMERGENCY DEPARTMENT.

2021 ◽  
pp. 8-13
Author(s):  
Pankaj Kumar Singh ◽  
Budhaditya Sanyal ◽  
Mohit Bhatnagar ◽  
Mandeep Joshi ◽  
Shreya Verma
Keyword(s):  
Diagnostic Accuracy ◽  
Endotracheal Tube ◽  
Predictive Value ◽  
Static Method ◽  
Tube Placement ◽  
Short Course ◽  
Endotracheal Tube Placement ◽  
Linear Probe ◽  
Post Intubation ◽  
Sensitivity Specificity

Aims and objectives: This study aims to assess the diagnostic accuracy and timeliness of ultrasonography by static method only for identication of Endotracheal tube (ET Tube) placement in the trachea in emergency settings vs existing clinical methods. Material and Methods: This prospective study was carried out in the emergency room from October 2018 till the end of March 2019. The ultrasonography was performed in 120 emergency patients only after the intubation had been completed ie, static phase. A linear probe was used over the neck to identify the predened signs of ET intubation. Residents who perform ultrasound examination ll a form after assessment of each patient. Results: It was found that Tracheal Intubation-USG Sensitivity was 99.1, Specicity was 91.7, Positive Predictive Value: 99.1, Negative Predictive Value was 91.7 and Accuracy was 98.3%. Ultrasonography can be used as an adjunct tool to verify the ETTposition by Emergency Physicians which can be performed easily after a brieng or short-course training.Conclusion:This study demonstrates that US imaging has a high diagnostic accuracy to immediately conrm proper ETT placement post-intubation in an emergency setup. Therefore, it seems that ultrasonography using a static technique only is a proper screening tool in determining endotracheal tube placement.

Sign in / Sign up

Export Citation Format

Share Document