Joxhorst, N. (Niek) (2014) Controle van de positie van een endotracheale tube door middel van spirometrie. thesis, Medicine.
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Abstract
Background: In order to perform a correct intubation, it is clear that an endotracheal tube needs to be positioned in the trachea, and not in the oesophagus. In an elective setting, there are a number of methods to detect the position of the tube. During emergency situations in the field with suboptimal working conditions, verification of the position of the tube is much harder and research shows that in up to 17% of the intubations, the tube is positioned in the oesophagus, with all its consequences. This shows there is a need for a new method to detect the position of the tube reliably and fast. Previous research shows that pressure waveforms, obtained from spirometry after intubation, show a significant difference between tracheal and oesophageal intubations. On this basis an algorithm was developed and tested, so far with a sensitivity and specificity of 100%. A new handy detection device is developed, that is, by means of the algorithm, able to distinguish between a tracheal and an oesophageal intubation. The efficacy of this new detection method however, needs verification. That is the target of this study. Methods: For this study, 60 people will be included, after their written informed consent. These patients will, alongside of the tracheal intubation that is needed for their surgery, also be intubated in the oesophagus. So at that moment, there are two tubes in situ. Both tubes get the detection device installed. The mechanical ventilation of the tracheal tube is paused. A switch is made to manual ventilation of both the tracheal and the oesophageal tube. Each tube is ventilated three times. The anaesthesiologist that operates the ventilation balloon, does not know which tube he is ventilating. The diagnosis that the detection device shows is recorded. Afterwards the diagnosis will be compared to the real event. Based on this data, a sensitivity and a specificity is calculated. Results: For this study, up to now, 13 people are included. In these patients, 38 tracheal and 39 oesophageal ventilations were performed and analysed. In one patient, an oesophageal intubation is detected as a tracheal intubation. All tracheal ventilations were detected as such. Based on this data, a sensitivity of 100% and a specificity of 97% is calculated. Conclusion: Based on the first results of this study, the conclusion is that the algorithm can detect the position of the tube with high sensitivity and specificity and, integrated in a detection device it is a good new method. The handiness and the potential to detect the position after just one ventilation, makes it a great method to detect the position of the tube in suboptimal working conditions.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Kalmar, Dr. A.F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:40 |
| Last Modified: | 25 Jun 2020 10:40 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/213 |
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