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Alenazi A, Alshibani A. Confirmatory methods for endotracheal tube placement in out-of-hospital settings: A systematic review of the literature. Heliyon 2024; 10:e28479. [PMID: 38586363 PMCID: PMC10998048 DOI: 10.1016/j.heliyon.2024.e28479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Confirming proper placement of an endotracheal tube (ETT) is important, as accidental misplacements may occur and lead to critical injuries, potentially leading to adverse outcomes. Multiple methods are available for determining the correct ETT placement in prehospital care. Objective To assess the accuracy and reliability of the different methods used to confirm endotracheal intubation in prehospital settings. Methods A comprehensive literature search was performed in the MEDLINE, EMBASE, Scopus, and Web of Science databases for studies that were published between 1-June-1992 and 12-June-2022 using a combination of predetermined search terms. Studies that met the inclusion criteria were included and assessed for risk of bias using "Risk of Bias in Non-randomized Studies of Intervention" tool. Results Of the 1016 identified studies, nine met the inclusion criteria. Capnography and point-of-care ultrasound showed high sensitivity and specificity rates when applied to confirm ETT placement in prehospital care. Other methods including capnometry, colorimetric detectors, ODDs, and auscultation showed varied sensitivity and specificity. Patient comorbidities and device failure contributed to decreased accuracy rates in prehospital care. Capnography was less reliable in distinguishing between endotracheal intubation and right main stem intubation, which is known as a complication in out-of-hospital endotracheal intubation. Point-of-care ultrasound was more accurate and reliable in detecting oesophageal and endobronchial misplacements. ETCO2 monitors, i.e., capnometry and colorimetric detectors, were less reliable in patients with low perfusion states. Conclusion This systematic review showed that there is no single method with 100% accuracy in confirming the correct ETT placement and detecting the occurrence of accidental oesophageal or endobronchial misplacements in prehospital care. Further studies with a larger sample size are needed to assess the accuracy of multiple confirmatory methods in prehospital settings.
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Affiliation(s)
- Amani Alenazi
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Alshibani
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Zimmermann GS, Palm J, Lahmann AL, Peltz F, Okrojek R, Weis F, Müller A, Ziegler T, Steger A, Haller B, Hoppmann P, Laugwitz KL, Hautmann H. Early Bronchoscopy Improves Extubation Rates after Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Analysis. J Clin Med 2021; 10:jcm10143055. [PMID: 34300221 PMCID: PMC8306153 DOI: 10.3390/jcm10143055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients suffering from out-of-hospital cardiac arrest (OHCA) frequently receive a bronchoscopy after being admitted to the ICU. We investigated the optimal timing and the outcome in these patients. METHODS All patients who suffered from OHCA and were treated in our ICU from January 2013 to December 2018 were retrospectively analyzed. The data were collected from the patients' medical files, and included duration of mechanical ventilation, antibiotics, microbiological test results and neurological outcome. The outcome was the effect of early bronchoscopy (≤48 h after administration) on the rate of intubated patients on day five and day seven. RESULTS From January 2013 to December 2018, 190 patients were admitted with OHCA. Bronchoscopy was performed in 111 patients out of the 164 patients who survived the first day. Late bronchoscopy >48 h was associated with higher rates of intubation on day five (OR 4.94; 95% CI 1.2-36.72, 86.7% vs. 55.0%, p = 0.036) and day seven (OR 4.96; 95% CI 1.38-24.69; 80.0% vs. 43.3%, p = 0.019). CONCLUSION This study shows that patients who suffered from OHCA might have a better outcome if they receive a bronchoscopy early after hospital admission. Our data suggests an association of early bronchoscopy with a shorter intubation period.
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Affiliation(s)
- Gregor S. Zimmermann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
- Correspondence:
| | - Jana Palm
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Anna Lena Lahmann
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, 80636 Munich, Germany;
| | - Friedhelm Peltz
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Rainer Okrojek
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Florian Weis
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Arne Müller
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Tilman Ziegler
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Alexander Steger
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Technical University of Munich, 81675 Munich, Germany;
| | - Petra Hoppmann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Karl-Ludwig Laugwitz
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
| | - Hubert Hautmann
- Department of Internal Medicine I, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, 81675 Munich, Germany; (J.P.); (F.P.); (R.O.); (F.W.); (A.M.); (T.Z.); (A.S.); (P.H.); (K.-L.L.); (H.H.)
- Department of Internal Medicine, Klinik Ottobeuren, 87724 Ottobeuren, Germany
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Drnovšek R, Milavec Kapun M, Rajkovič U. Multi-criteria risk evaluation model for developing ventilator-associated pneumonia. CENTRAL EUROPEAN JOURNAL OF OPERATIONS RESEARCH 2020; 29:1021-1036. [PMID: 33362431 PMCID: PMC7750785 DOI: 10.1007/s10100-020-00720-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
Ventilator-associated pneumonia is a hospital-acquired infection of the lungs occurring in mechanically ventilated patients. An active risk management approach can prevent the occurrence of the disease and promote positive organizational changes, subsequently decreasing mortality and hospitalization costs. Using scientific and clinical practice knowledge, a risk evaluation model was developed to identify patients more at risk of developing the disease. For this purpose, a Decision Expert qualitative multi-criteria decision method was used, in which alternatives are evaluated according to predetermined hierarchically arranged criteria. Characteristics of each evaluated alternative are described by the members of an interdisciplinary expert team and are represented by the values of the basic criteria. Values of hierarchically higher aggregated criteria are computed in an upwards fashion according to utility functions, which are defined as simple logical rules. This method is integrated into a software solution, DEXi. The approach is applicable to vastly diverse decision problems and has been successfully used before for health-related decision support. The designed model was tested using actual clinical data. Evaluations of alternatives that most distinctly demonstrated the functionality of the evaluation model were selected and are presented in the results. The evaluation model is intended to assist a holistic evaluation of the risk of developing ventilator-associated pneumonia, by considering patient-related risk factors and the use of preventive measures. The model incorporates nursing-specific data that have hitherto been poorly utilized in preventing ventilator-associated pneumonia and promotes the active engagement of nurses in confronting this interdisciplinary healthcare problem, which has gained more prominence with the onset of COVID-19 disease.
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Affiliation(s)
- Rok Drnovšek
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
- University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
| | - Marija Milavec Kapun
- Faculty of Health Sciences, University of Ljubljana, Zdravstvena pot 5, 1000 Ljubljana, Slovenia
| | - Uroš Rajkovič
- Faculty of Organizational Sciences, University of Maribor, Kidričeva cesta 55a, 4000 Kranj, Slovenia
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