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Abstract
Although endotracheal intubation is usually a simple and fast procedure in dogs, some situations can be challenging and lead to the risk of tube misplacement in the esophagus—a life-threatening complication. Hence, confirming intubation is a cornerstone whenever this procedure is performed. Methods such as direct visualization or capnography present limitations insofar as they may be unreliable or unavailable under some circumstances. Ultrasound has emerged as a promising tool to confirm intubation in medicine. However, so far little research has been done on the subject in veterinary medicine. This study’s main goal was to investigate ultrasound performed by veterinary students as a confirmation method for intubation in canine cadavers after a brief training session (25 minutes). A total of 160 exams were performed with a microconvex probe by 20 students in 11 different cadavers on left and right recumbencies. Overall accuracy was 70.6% with a median success rate of 75% and a median time to diagnosis of 25 seconds. The number of correct diagnoses was statistically higher than the wrong ones (p<0.05) without difference between recumbencies. Sensitivity, specificity, and positive and negative predictive values were 72.5%, 68.8%, 69.9%, and 71.4%, respectively. The fastest diagnosis was performed in just 4 seconds, and among the top-performers, one student had 100% accuracy with a mean time to diagnosis of 16.8 seconds, and four students had approximately 88% accuracy. This study showed for the first time that even inexperienced veterinary students can have acceptable accuracy in confirming endotracheal intubation in dogs after a brief training session.
References
Abbasi, S., Farsi, D., Zare, M. A., Hajimohammadi, M., Rezai, M., & Hafezimoghadam, P. (2015). Direct ultrasound methods: A confirmatory technique for proper endotracheal intubation in the emergency department. European Journal of Emergency Medicine, 22(1), 10-16. http://dx.doi.org/10.1097/MEJ.0000000000000108. PMid:24441884.
Apfelbaum, J. L., Hagberg, C. A., Connis, R. T., Abdelmalak, B. B., Agarkar, M., Dutton, R. P., Fiadjoe, J. E., Greif, R., Klock Junior, P. A., Mercier, D., Myatra, S. N., O’Sullivan, E. P., Rosenblatt, W. H., Sorbello, M., & Tung, A. (2022). 2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway*. Anesthesiology, 136(1), 31-81. http://dx.doi.org/10.1097/ALN.0000000000004002. PMid:34762729.
Chenkin, J., McCartney, C. J. L., Jelic, T., Romano, M., Heslop, C., & Bandiera, G. (2015). Defining the learning curve of point-of-care ultrasound for confirming endotracheal tube placement by emergency physicians. Critical Ultrasound Journal, 7(1), 14. http://dx.doi.org/10.1186/s13089-015-0031-7. PMid:26383011.
Chou, H.-C., Tseng, W.-P., Wang, C.-H., Ma, M. H.-M., Wang, H.-P., Huang, P.-C., Sim, S.-S., Liao, Y.-C., Chen, S.-Y., Hsu, C.-Y., Yen, Z.-S., Chang, W.-T., Huang, C.-H., Lien, W.-C., & Chen, S.-C. (2011). Tracheal rapid ultrasound exam (T.R.U.E.) for confirming endotracheal tube placement during emergency intubation. Resuscitation, 82(10), 1279-1284. http://dx.doi.org/10.1016/j.resuscitation.2011.05.016. PMid:21684668.
Gottlieb, M., Alerhand, S., & Long, B. (2020). Point-of-care ultrasound for intubation confirmation of COVID-19 patients. The Western Journal of Emergency Medicine, 21(5), 1042-1045. http://dx.doi.org/10.5811/ westjem.2020.7.48657. PMid:32970551.
Gottlieb, M., Bailitz, J. M., Christian, E., Russell, F. M., Ehrman, R. R., Khishfe, B., Kogan, A., & Ross, C. (2014). Accuracy of a novel ultrasound technique for confirmation of endotracheal intubation by expert and novice emergency physicians. The Western Journal of Emergency Medicine, 15(7), 834-839. http://dx.doi.org/10.5811/ westjem.22550.9.22550. PMid:25493129.
Gottlieb, M., Holladay, D., Burns, K., Gore, S. R., Wulff, C., Shah, S., & Bailitz, J. (2019). Accuracy of ultrasound for endotracheal intubation between different transducer types. The American Journal of Emergency Medicine, 37(12), 2182-2185. http://dx.doi.org/10.1016/j.ajem.2019.03.016. PMid:30890289.
Grubb, T., Sager, J., Gaynor, J. S., Montgomery, E., Parker, J. A., Shafford, H., & Tearney, C. (2020). 2020 AAHA anesthesia and monitoring guidelines for dogs and cats. Journal of the American Animal Hospital Association, 56(2), 59-82. http://dx.doi.org/10.5326/JAAHA-MS-7055. PMid:32078360.
Herreria-Bustillo, V. J., Kuo, K. W., Burke, P. J., Cole, R., & Bacek, L. M. (2016). A pilot study evaluating the use of cervical ultrasound to confirm endotracheal intubation in dogs. Journal of Veterinary Emergency and Critical Care (San Antonio, Tex.), 26(5), 654-658. http://dx.doi.org/10.1111/vec.12507. PMid:27385124.
Honardar, M. R., Posner, K. L., & Domino, K. B. (2017). Delayed detection of esophageal intubation in anesthesia malpractice claims: Brief report of a case series. Anesthesia and Analgesia, 125(6), 1948-1951. http://dx.doi. org/10.1213/ANE.0000000000001795. PMid:28207593.
Liu, Y., Ma, W., & Liu, J. (2023). Applications of airway ultrasound for endotracheal intubation in pediatric patients: A systematic review. Journal of Clinical Medicine, 12(4), 1477. http://dx.doi.org/10.3390/jcm12041477.
Muslu, B., Sert, H., Kaya, A., Demircioglu, R. I., Gözdemir, M., Usta, B., & Boynukalin, K. S. (2011). Use of sonography for rapid identification of esophageal and tracheal intubations in adult patients. Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine, 30(5), 671-676. http://dx.doi. org/10.7863/jum.2011.30.5.671. PMid:21527615.
Raphael, D. T., & Conard III, F. U. (1987). Ultrasound confirmation of endotracheal tube placement. Journal of Clinical Ultrasound, 15(7), 459-462. http://dx.doi.org/10.1002/jcu.1870150706. PMid:3134447.
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Copyright (c) 2023 Bruno Augusto da Silva Rezende, Nicolle Gouvêa Bottoni, Ângelo Gustavo Novello de Oliveira, Lucas Baptista Motta, Fabio Sartori, Eduardo Butturini de Carvalho