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Mousavi SM, Sayyari Doughabadi M, Alamdaran SA, Sadrzadeh SM, Zakeri H, VafadarMoradi E. Diagnostic Accuracy of Suprasternal Versus Subxiphoid Ultrasonography for Endotracheal Intubation. Anesth Pain Med 2022; 12:e118592. [PMID: 35433372 PMCID: PMC8995869 DOI: 10.5812/aapm.118592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/20/2022] [Accepted: 02/20/2022] [Indexed: 11/16/2022] Open
Abstract
Background Airway management is an important skill for emergency physicians, and confirmation of correct endotracheal tube (ETT) placement is a crucial component of airway management. Objectives Due to the occurrence of incorrect ETT positioning in emergency departments, the present study aimed to compare the diagnostic sensitivity of ultrasound using suprasternal and subxiphoid methods for confirming the correct placement of ETT compared to capnography. Methods This cross-sectional study was conducted by examining patients requiring intubation. Ultrasound was performed by two independent emergency medical assistants using two suprasternal and subxiphoid methods to confirm correct ETT placement; the results were then interpreted. To observe the tube passage through the vocal cords, capnography and lung auscultation were applied as the gold standards, and the results of two ultrasound methods were compared. Results A total of 66 patients, who were intubated in the emergency department, participated in this study. The positive and negative predictive values, sensitivity, and specificity of supernatural ultrasound were 96.72%, 80%, 98.33%, and 66.67%, respectively. Also, positive and negative predictive values, sensitivity, and specificity of subxiphoid ultrasound were 97.95%, 29.41%, 80%, and 83.33%, respectively. The diagnostic odds ratios of suprasternal and subxiphoid ultrasounds were 1.026 and 1.024 compared to capnography, respectively. Conclusions Ultrasonography using the suprasternal method was feasible. Considering the high sensitivity and specificity of this method in confirming correct ETT placement, it produced reliable results. Overall, this modality can be used as one of the main methods to verify correct ETT placement in emergency departments.
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Affiliation(s)
- Seyed Mohammad Mousavi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sayyari Doughabadi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ali Alamdaran
- Radiology Department, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sayyed Majid Sadrzadeh
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Zakeri
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elnaz VafadarMoradi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Corresponding Author: Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Farrokhi M, Yarmohammadi B, Mangouri A, Hekmatnia Y, Bahramvand Y, Kiani M, Nasrollahi E, Nazari-Sabet M, Manoochehri-Arash N, Khurshid M, Mosalanejad S, Hajizadeh V, Amani-Beni R, Moallem M, Farahmandsadr M. Screening Performance Characteristics of Ultrasonography in Confirmation of Endotracheal Intubation; a Systematic Review and Meta-analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2021; 9:e68. [PMID: 34870234 PMCID: PMC8628646 DOI: 10.22037/aaem.v9i1.1360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction: Recent studies have suggested that point-of-care ultrasonography can be used for confirming the placement of endotracheal tube. This systematic review and meta-analysis aimed to investigate the sensitivity and specificity of ultrasonography for confirming endotracheal tube placement. Methods: In this meta-analysis, systematic search of the previous published papers investigating the diagnostic accuracy of ultrasonography for confirmation of endotracheal tube placement was performed. Seven electronic databases, including PubMed, Scopus, Google Scholar, EBSCO, EMBASE, Web of Science, and Cochrane Database were searched up to July 2021, for all relevant articles published in English on this topic. Meta-DiSc version 1.4 software was used for statistical analysis. Results: The estimated pooled sensitivity and specificity of ultrasonography for confirmation of endotracheal tube location were 0.98 (95% CI: 0.98–0.99) and 0.94 (95% CI 0.91–0.96), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 5.94 (95% CI 4.41–7.98) and 0.03 (95% CI: 0.02-0.04), respectively. The diagnostic odds ratio of ultrasonography was 281.47 and the area under hierarchical summary receiver operating characteristic (HSROC) revealed an appropriate accuracy of 0.98. Conclusion: Ultrasonography has high diagnostic accuracy and can be used as a promising tool for confirmation of endotracheal tube placement, especially in critically ill patients or when capnography is not available, or its result is equivocal.
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Affiliation(s)
| | - Bardia Yarmohammadi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Mangouri
- Department of Vascular and Endovascular Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Yasaman Hekmatnia
- Islamic Azad University, Sari Branch, School of Medicine, Sari, Iran
| | - Yaser Bahramvand
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Moein Kiani
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Elham Nasrollahi
- School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Nazari-Sabet
- Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Niusha Manoochehri-Arash
- Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maria Khurshid
- Department of Internal Medicine, Berkshire Medical Center, Pittsfield, Massachusetts, USA
| | - Shima Mosalanejad
- Department of Internal Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Vida Hajizadeh
- School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoumeh Moallem
- Department of Emergency Medicine, School of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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Deshwal H, Pradhan D, Mukherjee V. Point-of-care ultrasound in a pandemic: Practical guidance in COVID-19 units. World J Crit Care Med 2021; 10:204-219. [PMID: 34616657 PMCID: PMC8462027 DOI: 10.5492/wjccm.v10.i5.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 06/05/2021] [Accepted: 07/06/2021] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has stretched our healthcare system to the brink, highlighting the importance of efficient resource utilization without compromising healthcare provider safety. While advanced imaging is a great resource for diagnostic purposes, the risk of contamination and infection transmission is high and requires extensive logistical planning for intrahospital patient transport, healthcare provider safety, and post-imaging decontamination. This dilemma has necessitated the transition to more bedside imaging. More so than ever, during the current pandemic, the clinical utility and importance of point-of-care ultrasound (POCUS) cannot be overstressed. It allows for safe and efficient beside procedural guidance and provides front line providers with valuable diagnostic information that can be acted upon in real-time for immediate clinical decision-making. The authors have been routinely using POCUS for the management of COVID-19 patients both in the emergency department and in intensive care units turned into “COVID-units.” In this article, we review the nuances of using POCUS in a pandemic situation and maximizing diagnostic output from this bedside technology. Additionally, we review various methods and diagnostic uses of POCUS which can replace conventional imaging and bridge current literature and common clinical practices in critically ill patients. We discuss practical guidance and pertinent review of the literature for the most relevant procedural and diagnostic guidance of respiratory illness, hemodynamic decompensation, renal failure, and gastrointestinal disorders experienced by many patients admitted to COVID-units.
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Affiliation(s)
- Himanshu Deshwal
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Deepak Pradhan
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
| | - Vikramjit Mukherjee
- Division of Pulmonary, Sleep and Critical Care Medicine, New York University Grossman School of Medicine, New York, NY 10016, United States
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Vernieuwe L, Van de Putte P, Deen J, Bouchez S. Focus on PoCUS or hocus pocus? Integrating point-of-care ultrasound into residency and clinical practice. ACTA ANAESTHESIOLOGICA BELGICA 2020. [DOI: 10.56126/71.2.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Point-of care ultrasound (PoCUS) is a new clinical diagnostic paradigm that plays an instrumental role in the ongoing anesthesiologist’s evolving role towards a perioperative physician. Currently, there are few approved curricula that incorporate a PoCUS program into anesthesia residency. This article examines relevant PoCUS applications for anesthesiologists, presents an overview of existing international guidelines for education and training, and reflects on the need for specialty-wide standards. We present a possible framework, that could offer a first move towards a structured PoCUS pathway for Belgian anesthesia residents and facilitate its incorporation into national anesthesia practice.
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Soleimanpour M, Rahmani F, Morteza Bagi HR, Ala A, Mahmoodpoor A, Hassani F, Mahdi Sharifi S, Mehdizadeh Esfanjani R, Soleimanpour H. Comparison of Three Techniques on Facility of Bag-Mask Ventilation: Thenar Eminence, E-O and E-C. Anesth Pain Med 2018; 8:e74226. [PMID: 30250820 PMCID: PMC6139725 DOI: 10.5812/aapm.74226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/23/2018] [Accepted: 08/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background Rapid and secure management of airway is an important lifesaving intervention in critically ill patients at emergency wards. Training undergraduate students about airway management must be regarded as a priority in their education period. The aim of the present study was to compare the quality of three ventilation techniques with a bag and mask among two groups of undergraduate students (Novices) and senior group (Experienced) in Tabriz University of Medical Sciences. Methods This study was a mannequin type research that was carried out in the faculty of medicine, Tabriz University of Medical Sciences. The study population consisted of two elementary groups (Novices) and senior group (Experienced). The number of participants included 100 individuals. Ventilation quality by bag and mask in two groups was recorded based on the rise of lungs and two reviewers' opinions who gave a score from 1 as weak to 4 as excellent using three techniques of E-C, E-O, and Thenar Eminence. In the E-C technique, index fingers and thumbs form two “C”s facing each other while the remaining fingers lift the mandible and form two “E”s. In E-O techniques, the web between thumb and index finger is used to form a circle around the neck of the mask while other fingers perform a chin lift. In thenar eminence techniques, the thenar eminence and thumb are placed on the top of the mask while other fingers perform jaw thrust. Results In our study, 27% of undergraduate participants and 59% of seniors were male and the others were female. The mean of age of elementary and seniors were 24 and 33.5, respectively (P < 0.05). E-O technique was well done by the novices group. Conclusions Based on our results, it was concluded that the elementary group performed E-O bag and mask ventilation technique appropriately. Therefore, it can be suggested that training of this technique will be placed in educational curriculum of undergraduate students.
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Affiliation(s)
- Maryam Soleimanpour
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Rahmani
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Alireza Ala
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Anesthesiology Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Hassani
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Mahdi Sharifi
- Students’ Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Hassan Soleimanpour
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Corresponding Author: Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-9141164134, Fax: +98-4133341994,
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