Ignite Creation Date:
2024-10-26 @ 3:37 PM
Last Modification Date:
2024-10-26 @ 3:37 PM
Study NCT ID:
NCT06542406
Status:
COMPLETED
Last Update Posted:
None
First Post:
2024-07-26
Brief Title:
Can Endotracheal Tube Fluctuation With Epigastric Compression Be Used as a Confirmation Method for Endotracheal Intubation
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Can the Fluctuation Observed in the Endotracheal Tube With Compression Applied to the Epigastric Region be Used as a Confirmation Method for Endotracheal Intubation
Status:
COMPLETED
Status Verified Date:
2024-08
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Endotracheal intubation ETE may also need to be performed outside the hospital as advanced airway management In such cases facilities such as imaging methods ultrasound or capnography may not be available and only traditional methods such as auscultation of lung sounds auscultation of the epigastric region without hearing airflow observation of chest expansion after ventilation observation of water vapor in the tube may have to be used Despite all these observational methods and equipment used it is recommended to keep in mind that there may be errors and to try to provide confirmation with more than one method
Especially in disaster situations where technological infrastructure is not available and sometimes outside the hospital the use of traditional methods based on examination may be of vital importance The traditional methods mentioned above are mostly used to detect tracheal localization and to exclude esophageal localization In our observations in patients with cardiopulmonary arrest the investigators noticed that in the case of esophageal placement of the tube manual compression of the epigastric region produced a fluctuation in the tube and valved balloon caused by airflow The investigators thought that this could be a method to confirm esophageal placement The aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube
Especially in disaster situations where technological infrastructure is not available and sometimes outside the hospital the use of traditional methods based on examination may be of vital importance The traditional methods mentioned above are mostly used to detect tracheal localization and to exclude esophageal localization In our observations in patients with cardiopulmonary arrest the investigators noticed that in the case of esophageal placement of the tube manual compression of the epigastric region produced a fluctuation in the tube and valved balloon caused by airflow The investigators thought that this could be a method to confirm esophageal placement The aim of this study was to investigate the usefulness of epigastric manual compression in the confirmation of esophageal placement of the tube
Detailed Description:
Patients who underwent ETE outside the hospital or in the first hour of arrival to the emergency department were evaluated after the procedure Out-of-hospital ETE was performed by experienced paramedics working in the emergency ambulance service and ETE in the emergency department was performed by emergency medicine residents or emergency medicine specialists with at least 2 years of emergency department experience Out-of-hospital procedures were performed at the first visit to the emergency department and procedures performed in the emergency department were confirmed by ETE immediately after the procedure
Confirmation was performed single-blind by emergency medicine specialists with at least 5 years of experience without knowing who performed the procedure and where in or out of the hospital Confirmation was performed by auscultation of lung sounds from the anterior and lateral sides of both lungs upper and lower zones evaluation of equal participation of both thoraxes in breathing by inspection auscultation of the epigastric region placement of capnography monitoring of water vapor in the tube manual compression of the epigastric region at least three times and evaluation of fluctuation in the tube and pulse oximetry monitoring
Epigastric compression was performed by applying pressure to the epigastric region at least three times with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask During this procedure the fluctuation of the air and fluid in the stomach inside the esophageal tube can be observed and its sound can be heard It can be applied from the first inhalation
The ultrasonography USG procedure was evaluated by placing a linear ultrasound probe SonoSite M-Turbo linear probe 13-6 MHz Sonosite Inc Bothell WA USA in the transverse position on the anterior side of the neck just above the suprasternal notch and observing the position of the tube presence of a double path sign and pleural sliding movement While a single semicircular echogenic area is observed when the tube is in the trachea a second semicircular echogenic area is observed when the tube is located in the esophagus USG was performed immediately after the ETE procedure In patients in whom double pathway sign was observed and pleural sliding motion was not observed the patient was re-intubated by the experienced specialist performing USG It was confirmed by USG again These procedures were categorized as failed
partial endtidal carbon dioxide PETCO2 measurement by capnography was performed using a mainstream EMMA Capnograph PHASEIN AB Svärdvägen Danderyd Sweden for intubated patients It was assessed by the detection of PETCO2 greater than 5 mmHg after five breaths and the appearance of a typical square waveform
Confirmation was performed single-blind by emergency medicine specialists with at least 5 years of experience without knowing who performed the procedure and where in or out of the hospital Confirmation was performed by auscultation of lung sounds from the anterior and lateral sides of both lungs upper and lower zones evaluation of equal participation of both thoraxes in breathing by inspection auscultation of the epigastric region placement of capnography monitoring of water vapor in the tube manual compression of the epigastric region at least three times and evaluation of fluctuation in the tube and pulse oximetry monitoring
Epigastric compression was performed by applying pressure to the epigastric region at least three times with the volar side of the intubated patient while the patient was ventilated with a balloon-valved mask During this procedure the fluctuation of the air and fluid in the stomach inside the esophageal tube can be observed and its sound can be heard It can be applied from the first inhalation
The ultrasonography USG procedure was evaluated by placing a linear ultrasound probe SonoSite M-Turbo linear probe 13-6 MHz Sonosite Inc Bothell WA USA in the transverse position on the anterior side of the neck just above the suprasternal notch and observing the position of the tube presence of a double path sign and pleural sliding movement While a single semicircular echogenic area is observed when the tube is in the trachea a second semicircular echogenic area is observed when the tube is located in the esophagus USG was performed immediately after the ETE procedure In patients in whom double pathway sign was observed and pleural sliding motion was not observed the patient was re-intubated by the experienced specialist performing USG It was confirmed by USG again These procedures were categorized as failed
partial endtidal carbon dioxide PETCO2 measurement by capnography was performed using a mainstream EMMA Capnograph PHASEIN AB Svärdvägen Danderyd Sweden for intubated patients It was assessed by the detection of PETCO2 greater than 5 mmHg after five breaths and the appearance of a typical square waveform
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None