Plus d'auscultation mais une Echo ?

 Point of care ultrasound for orotracheal tube placement assessment in out-of hospital setting.

Zadel S et AL. Resuscitation. 2014 Nov 20;87C:1-6 

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A lire cet article, on comprend pourquoi l'engouement actuel pour l'échographie des voies aériennes. A coup sûr une technique à maîtriser en préhospitalier.

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AIM OF THE STUDY:

The percentage of unrecognised orotracheal tube displacement in an out-of-hospital setting has been reported to be between 4.8% and 25%. The aim of our study was to assess the sensitivity and specificity of Point-of-Care-UltraSound (POCUS) for confirming the propertube position after an urgent orotracheal intubation in an out-of-hospital setting and the time needed for POCUS.

METHODS:

Our single-centred prospective study included all patients who needed out-of-hospital orotracheal intubation. After the intubation, bilateral chest auscultation and assessment of bilateral lung sliding and diaphragm excursion within POCUS were done. Spectrographic quantitative capnography was used as the reference standard to confirm a proper tube position.

RESULTS:

We enrolled 124 patients. For auscultation, sensitivity and negative predicted value were 100%, specificity was 90% and positive predicted value 30% (95% confidence interval). 

Sensitivity, specificity, positive predicted value, and negative predicted value for POCUS alone and for a combination of auscultation and POCUS were 100% (95% confidence interval). In three patients, we detected endobronchial tube displacement with auscultation and POCUS. Capnography failed to detect displacement in all three cases. The median time needed for POCUS was 30s.

CONCLUSION:

Results of our study support POCUS as an accurate and reliable method for confirming the proper orotracheal tube placement in trachea and it is feasible for out-of-hospital setting implementation. POCUS also seems to be time saving method but to make definitive conclusion more studies should be done.