Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)

dc.contributorRodríguez Gómez, Ciro Alfonso
dc.contributorMeléndez Flórez, Héctor Julio
dc.contributorhttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609
dc.contributorhttps://orcid.org/0000-0003-1791-8099
dc.creatorArdila Torres, Luis Guillermo
dc.date.accessioned2020-08-05T16:19:16Z
dc.date.available2020-08-05T16:19:16Z
dc.date.created2020-08-05T16:19:16Z
dc.date.issued2020-06-30
dc.identifierhttp://hdl.handle.net/20.500.12749/7158
dc.identifierinstname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifierreponame:Repositorio Institucional UNAB
dc.identifierrepourl:https://repository.unab.edu.co
dc.description.abstractEl propósito del presente estudio es evaluar la utilidad de la ecografía como herramienta diagnóstica para determinar el mal posicionamiento del tubo endotraqueal (TET) en población pediátrica, pues su incidencia reportada es del 30-50%. Nuestra hipótesis infiere que el ultrasonido tiene una sensibilidad y especificidad mayor al 90% para establecer malposición. Métodos: Se recolectó una muestra a conveniencia, prospectiva, de pacientes que fueron intubados para recibir soporte ventilatorio en la Unidad de Cuidados intensivos neonatales, previo aval mediante consentimiento informado, se procedió a realizar la evaluación ecográfica y posterior cotejo con la radiografía de tórax. El resultado primario fue determinar la concordancia de mal posicionamiento del tubo endotraqueal del examen ecográfico y la radiografía de tórax. Resultados: La incidencia de malposición del TET en 14 eventos de intubación evaluados fue del 35,6%, la sensibilidad para determinar malposición por ecografía fue del 40%, la especificidad y el valor predictivo positivo del 100% y un valor predictivo negativo del 75%. Conclusiones: La ecografía es una herramienta útil para determinar una eventual malposición del tubo endotraqueal, soportada en su alta especificidad y alto valor predictivo positivo. Sin embargo, los signos ecográficos que determinan un correcto posicionamiento no son suficientes para determinar su adecuada posición, por lo tanto es necesario confirmarla con la radiografía de tórax, teniendo en cuenta la baja representabilidad muestral del presente estudio, se requieren estudios con un mayor tamaño muestral, con el fin de precisar el conocimiento sobre el rendimiento diagnóstico de la ecografía como herramienta para determinar su correcta o incorrecta posición del TET.
dc.languagespa
dc.publisherUniversidad Autónoma de Bucaramanga UNAB
dc.publisherFacultad Ciencias de la Salud
dc.publisherEspecialización en Anestesiología
dc.relation1. Sawyer T, Foglia E, Hatch LD, Moussa A, Ades A, Johnston L, et al. Improving neonatal intubation safety: A journey of a thousand miles. J Neonatal Perinatal Med. 2017;10(2):125–31.
dc.relation2. Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand. 2011;55(10):1155–73.
dc.relation3. Chou EH, Dickman E, Tsou PY, Tessaro M, Tsai YM, Ma MHM, et al. Ultrasonography for confirmation of endotracheal tube placement: A systematic review and meta-analysis. Resuscitation [Internet]. 2015;90:97–103. Available from: http://dx.doi.org/10.1016/j.resuscitation.2015.02.013
dc.relation4. Volsko TA, McNinch NL, Prough DS, Bigham MT. Adherence to Endotracheal Tube Depth Guidelines and Incidence of Malposition in Infants and Children. Respir Care. 2018;63(9):1111–7.
dc.relation5. Chowdhry R, Dangman B, Pinheiro JMB. The concordance of ultrasound technique versus X-ray to confirm endotracheal tube position in neonates. J Perinatol [Internet]. 2015;35(7):481–4. Available from: http://dx.doi.org/10.1038/jp.2014.240
dc.relation6. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Paediatr Anaesth. 2006;16(12):1238–43.
dc.relation7. Ramsingh D, Frank E, Haughton R, Schilling J, Gimenez K, Banh E, et al. Auscultation versus point-of-care ultrasound to determine endotracheal versus bronchial intubation. Anesthesiology [Internet]. 2016;124(5):1012– 20. Available from: http://www.embase.com/search/results?subaction=viewrecord&from=expo rt&id=L608901430%0Ahttp://dx.doi.org/10.1097/ALN.0000000000001073
dc.relation8. Foglia EE, Ades A, Napolitano N, Leffelman J, Nadkarni V, Nishisaki A. Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 57 Factors Associated with Adverse Events during Tracheal Intubation in the NICU. Neonatology. 2015;108(1):23–9.
dc.relation9. Harris EA, Arheart KL, Penning DH. Endotracheal tube malposition within the pediatric population: a common event despite clinical evidence of correct placement. Can J Anesth. 2008;55(10):685–90.
dc.relation10. Sitzwohl C, Langheinrich A, Schober A, Krafft P, Sessler DI, Herkner H, et al. Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: Randomised trial. BMJ. 2010;341(7783):1143.
dc.relation11. De Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, et al. Part 12: Pediatric advanced life support: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(18):S526–42.
dc.relation12. Schmölzer G, Roehr C. Techniques to ascertain correct endotracheal tube placement in neonates. Cochrane Database Syst Rev [Internet]. 2014;(9):N.PAG-N.PAG. Available from: http://oxfordbrookes.idm.oclc.org/login?url=http://search.ebscohost.com/lo gin.aspx?direct=true&db=cin20&AN=107769206&site=ehost-live
dc.relation13. Koshy T, Misra S, Chatterjee N, Dharan BS. Accuracy of a Chest X-Ray– Based Method for Predicting the Depth of Insertion of Endotracheal Tubes in Pediatric Patients Undergoing Cardiac Surgery. J Cardiothorac Vasc Anesth [Internet]. 2016;30(4):947–53. Available from: http://dx.doi.org/10.1053/j.jvca.2016.01.031
dc.relation14. Chung HW, Lee W Te, Chen HL. Reexamining the ideal depth of endotracheal tube in neonates. Pediatr Neonatol [Internet]. 2018;59(3):258–62. Available from: https://doi.org/10.1016/j.pedneo.2017.10.001
dc.relation15. Schmölzer GM, O’Reilly M, Davis PG, Cheung PY, Roehr CC. Confirmation of correct tracheal tube placement in newborn infants. Resuscitation [Internet]. 2013;84(6):731–7. Available from: http://dx.doi.org/10.1016/j.resuscitation.2012.11.028
dc.relation16. Todres D, DeBros F, Kramer SS, Moylan FMB, Shannon DC. Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 58 Endotracheal tube displacement in the newborn infant. J Pediatr [Internet]. 1976 Jul 1 [cited 2020 Jun 20];89(1):126–7. Available from: https://www.jpeds.com/article/S0022-3476(76)80946-8/pdf
dc.relation17. Sugiyama K, Yokoyama K. Displacement of the Endotacheal Tube Caused by Change of Head Position in Pediatric Anesthesia: Evaluation by Fiberoptic Bronchoscopy. Anesth Analg. 1996;82:251–3.
dc.relation18. Kim KO, Um WS, Kim CS. Comparative evaluation of methods for ensuring the correct position of the tracheal tube in children undergoing open heart surgery*. Anaesthesia [Internet]. 2003 Sep 1 [cited 2020 Jun 18];58(9):889–93. Available from: http://doi.wiley.com/10.1046/j.1365- 2044.2003.03336.x
dc.relation19. Weiss M, Knirsch W, Kretschmar O, Dullenkopf A, Tomaske M, Balmer C, et al. Tracheal tube-tip displacement in children during head-neck movement - A radiological assessment. Br J Anaesth. 2006;96(4):486–91.
dc.relation20. Marraro G. Airway Management. In: Marraro G, editor. Pediatric Anesthesia Basic Principles—State of the Art—Future. Toronto: People’s Medical Publishing House-USA; 2011. p. 1167–85.
dc.relation21. Sharma D, Tabatabaii SA, Farahbakhsh N. Role of ultrasound in confirmation of endotracheal tube in neonates : a review. J Matern Neonatal Med [Internet]. 2019;32(8):1359–67. Available from: https://doi.org/10.1080/14767058.2017.1403581
dc.relation22. Neunhoeffer F, Wahl T, Hofbeck M, Renk H, Esslinger M, Hanelt M, et al. A new method for determining the insertion depth of tracheal tubes in children: A pilot study. Br J Anaesth. 2016;116(3):393–7.
dc.relation23. Pek JH, Tan EM, Hao Y, Ong GY. Comparison of Formulae for Orotracheal Intubation Depth in the Paediatric Population. Ann Acad Med Singapore. 2018;47(4):138–42.
dc.relation24. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369–73.
dc.relation25. Bartle RMg, Miller AG, Diez AJ, Smith PB, A GM, Puia-Dumitrescu M. Evaluating Endotracheal Tube Depth in Infants Weighing Less Than 1 Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 59 Kilogram. Respir Care. 2019;64(3):243–7.
dc.relation26. Lee SU, Jung JY, Kim DK, Kwak YH, Kwon H, Cho JH, et al. New decision formulas for predicting endotracheal tube depth in children: analysis of neck CT images. Emerg Med J. 2018;35(5):303–8.
dc.relation27. Fiadjoe JE, Litman RS, Serber JF, Stricker PA, Coté CJ. The Pediatric Airway [Internet]. Sixth Edit. A Practice of Anesthesia for Infants and Children. Elsevier Inc.; 2018. 297-339.e21 p. Available from: https://doi.org/10.1016/B978-0-323-42974-0.00014-8
dc.relation28. Holzman RS. Airway Management. In: Holszman R, editor. Smith’s Anesthesia for Infants and Children [Internet]. Ninth Edit. Philadelphia: Elsevier Inc.; 2017. p. 349–69. Available from: http://dx.doi.org/10.1016/B978-0-323-34125-7.00018-8
dc.relation29. Boensch M, Schick V, Spelten O, Hinkelbein J. Estimation of the optimal tube length : Systematic review article on published formulae for infants and children. Anaesthesist. 2015;65(2):115–21.
dc.relation30. Manica D, de Souza Saleh Netto C, Schweiger C, Sekine L, Enéas LV, Pereira DR, et al. Association of endotracheal tube repositioning and acute laryngeal lesions during mechanical ventilation in children. Eur Arch Oto-Rhino-Laryngology. 2017;274(7):2871–6.
dc.relation31. Petrucci N, Iacovelli W. Ventilation with lower tidal volumes versus traditional tidal volumes in adults for acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev [Internet]. 2003 Jan 7 [cited 2020 Jun 22];(1):1–21. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003844/f ull
dc.relation32. Rimensberger PC, Cheifetz IM, Jouvet P, Thomas NJ, Willson DF, Erickson S, et al. Ventilatory support in children with pediatric acute respiratory distress syndrome: Proceedings from the pediatric acute lung injury consensus conference. Pediatr Crit Care Med. 2015;16(5):S51–60.
dc.relation33. Orloff KE, Turner DA, Rehder KJ. The Current State of Pediatric Acute Respiratory Distress Syndrome. Pediatr Allergy Immunol Pulmonol [Internet]. 2019 Jun 1 [cited 2020 Jun 20];32(2):35–44. Available from: Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 60 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589490/pdf/ped.2019.099 9.pdf
dc.relation34. Curley GF, Laffey JG, Zhang H, Slutsky AS, Laffey P. Biotrauma and Ventilator-Induced Lung Injury Clinical Implications. Chest [Internet]. 2016 Nov [cited 2020 Jun 22];150(5):1109–17. Available from: http://dx.doi.org/10.1016/j.chest.2016.07.019
dc.relation35. Klingenberg C, Wheeler KI, Mccallion N, Morley CJ, Davis PG. Volumetargeted versus pressure-limited ventilation in neonates. Cochrane Database Syst Rev [Internet]. 2017 Oct 17 [cited 2020 Jun 22];2017(10):1–91. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003666.p ub4/epdf/full
dc.relation36. Khemani RG, Conti D, Alonzo TA, Bart RD, Newth CJL, Khemani RG, et al. Effect of tidal volume in children with acute hypoxemic respiratory failure. Intensive Care Med [Internet]. 2009 Jun 17 [cited 2020 Jun 21];35:1428–37. Available from: https://link.springer.com/content/pdf/10.1007/s00134-009-1527-z.pdf
dc.relation37. Chenkin J, McCartney CJL, Jelic T, Romano M, Heslop C, Bandiera G. Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians. Crit Ultrasound J. 2015;7(1):7–14.
dc.relation38. Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A Prospective Comparison of Diaphragmatic Ultrasound and Chest Radiography to Determine Endotracheal Tube Position in a Pediatric Emergency Department. Pediatrics [Internet]. 2009;123(6):e1039–44. Available from: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2008-2828
dc.relation39. Alonso Quintela P, Oulego Erroz I, Mora Matilla M, Rodríguez Blanco S, Mata Zubillaga D, Regueras Santos L. Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal. An Pediatr [Internet]. 2014;81(5):283–8. Available from: http://dx.doi.org/10.1016/j.anpedi.2014.01.004
dc.relation40. Das SK, Choupoo NS, Haldar R, Lahkar A. Transtracheal ultrasound for Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 61 verification of endotracheal tube placement: a systematic review and meta-analysis. Can J Anesth Can d’anesthésie. 2015;62(4):413–23.
dc.relation41. Kajekar P, Mendonca C, Gaur V. Role of Ultrasound in Airway Assessment and Management. Int J Ultrasound Appl Technol Perioper Care [Internet]. 2010;(May 2010):97–100. Available from: http://www.jaypeejournals.com/eJournals/ShowText.aspx?ID=896&Type= FREE&TYP=TOP&IN=_eJournals/International Journal of Ultrasound and Applied Technologies in Perioperative Care.jpg&IID=80&AID=14&Year=2010&isPDF=YES
dc.relation42. Vijaykumar R, Saboo AR. Review of Different Methods Used for Confirmation of Endotracheal Tube Placement in Newborns. J Neonatal Biol. 2014;3(4):2–5.
dc.relation43. Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: Best evidence, techniques, and clinical impact. Br J Anaesth. 2016;117(S1):i39–48.
dc.relation44. Fiadjoe JE, Stricker P, Gurnaney H, Nishisaki A, Rabinowitz A, Gurwitz A, et al. Ultrasound-guided Tracheal Intubation. Anesthesiology [Internet]. 2012;117(6):1389–91. Available from: http://anesthesiology.pubs.asahq.org/Article.aspx?doi=10.1097/ALN.0b01 3e3182746a30
dc.relation45. Galicinao J, Bush AJ, Godambe SA. Use of Bedside Ultrasonography for Endotracheal Tube Placement in Pediatric Patients: A Feasibility Study. Pediatrics [Internet]. 2007;120(6):1297–303. Available from: http://pediatrics.aappublications.org/cgi/doi/10.1542/peds.2006-2959
dc.relation46. Stafrace S, Engelhardt T, Teoh WH, Kristensen MS. Essential ultrasound techniques of the pediatric airway. Pediatr Anesth. 2016;26(2):122–31.
dc.relation47. Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: From the mouth to the lungs and pleurae. Insights Imaging. 2014;5(2):253–79.
dc.relation48. Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: point of care in children – the time is now. Pediatr Anesth. 2020;0(0):1–6.
dc.relation49. Tessaro MO, Salant EP, Arroyo AC, Haines LE, Dickman E. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation [Internet]. 2015;89(C):8–12. Available from: http://dx.doi.org/10.1016/j.resuscitation.2014.08.033
dc.relation50. Kerrey BT, Rinderknecht AS, Geis GL, Nigrovic LE, Mittiga MR. Rapid sequence intubation for pediatric emergency patients: Higher frequency of failed attempts and adverse effects found by video review. Ann Emerg Med [Internet]. 2012;60(3):251–9. Available from: http://dx.doi.org/10.1016/j.annemergmed.2012.02.013
dc.relation51. Park SC, Ryu JH, Yeom SR, Jeong JW, Cho SJ. Confirmation of endotracheal intubation by combined ultrasonographic methods in the emergency department. EMA - Emerg Med Australas. 2009;21(4):293–7.
dc.relation52. Marciniak B, Fayoux P, Hébrard A, Krivosic-Horber R, Engelhardt T, Bissonnette B. Airway management in children: Ultrasonography assessment of tracheal intubation in real time? Anesth Analg. 2009;108(2):461–5.
dc.relation53. Clifford M, Butt W. Tracheal tube insertion is an essential part of modern paediatric anaesthesia and critical care: Let us get it right. Br J Anaesth. 2016;116(5):582–4.
dc.relation54. Lin MJ, Gurley K, Hoffmann B. Bedside Ultrasound for Tracheal Tube Verification in Pediatric Emergency Department and ICU Patients: A Systematic Review∗. Pediatr Crit Care Med. 2016;17(10):e469–76.
dc.relation55. Abbasi S, Farsi D, Zare MA, Hajimohammadi M, Rezai M, Hafezimoghadam P. Direct ultrasound methods: A confirmatory technique for proper endotracheal intubation in the emergency department. Eur J Emerg Med. 2015;22(1):10–6.
dc.relation56. Ahn JH, Kwon E, Lee SY, Hahm TS, Jeong JS. Ultrasound-guided lung sliding sign to confirm optimal depth of tracheal tube insertion in young children. Br J Anaesth [Internet]. 2019;123(3):309–15. Available from: https://doi.org/10.1016/j.bja.2019.03.020
dc.relation57. Kundra P, Mishra SK, Ramesh A. Ultrasound of the airway. Indian J Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica Fecha: 30/06/2020 Versión: 10 63 Anaesth. 2011;55(5):456–62.
dc.relation58. Verghese ST, Hannallah RS, Slack MC, Cross RR, Patel KM. Auscultation of bilateral breath sounds does not rule out endobronchial intubation in children. Anesth Analg. 2004;99(1):56–8.
dc.relation59. Canadian point of care ultrasound society. Protección y desinfección de ecógrafos de carro durante la pandemia por COVID-19 [Internet]. Disinfection protocols for ultrasound machines during COVID-19 management. 2020 [cited 2020 Jun 17]. p. 1–2. Available from: https://www.cpocus.ca/covid-19/disinfecting-protocols/
dc.relation60. Ministerio de Salud y Protección Social. Limpieza y Desinfección en Servicios de Salud ante la introducción del nuevo coronavirus (SARSCoV- 2) a Colombia [Internet]. Bogotá, Colombia; 2020 Mar [cited 2020 Jun 17]. Available from: https://www.minsalud.gov.co/Ministerio/Institucional/Procesos y procedimientos/GIPS07.pdf
dc.rightshttp://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rightsAbierto (Texto Completo)
dc.rightsinfo:eu-repo/semantics/openAccess
dc.rightshttp://purl.org/coar/access_right/c_abf2
dc.rightsAtribución-NoComercial-SinDerivadas 2.5 Colombia
dc.titleValoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)


Este ítem pertenece a la siguiente institución