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Z Geburtshilfe Neonatol 2022; 226(03): 160-166
DOI: 10.1055/a-1732-7867
Übersicht

Ultraschallgestützte Lagekontrolle des Endotrachealtubus bei Neugeborenen

Evaluation of the Endotracheal Tube by Ultrasound in Neonates
Jan Sandig 
1   Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
Christoph Bührer
1   Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
,
Christoph Czernik
1   Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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Zusammenfassung

Eine sichere Evaluation der korrekten Lage eines Endotrachealtubus ist eine wichtige Herausforderung in der Neonatologie. Der Point-of-Care Ultrasound ist eine neue Methode zur Beantwortung dieser Fragestellung, die rasch verfügbar ist, keine Strahlenexposition verursacht, mit niedrigem Personalaufwand verbunden ist und eine geringe Belastung für die Neugeborenen darstellt. Dieser Übersichtsartikel legt einen Fokus auf die Evaluation der klinischen Anwendbarkeit des Point-of-Care Ultrasound zur Untersuchung der Position des Tubus anhand von drei praxisrelevanten Fragestellungen zur Darstellbarkeit, Vergleichbarkeit mit dem Standard der Röntgenuntersuchung und dem Trainingsaufwand der Untersuchungstechnik. Im ersten Schritt wurden neun Studien identifiziert, die zur Beantwortung der Fragestellungen herangezogen wurden. Eine Darstellung der Spitze des Tubus ist mit Hilfe des Point-of-Care Ultrasound sehr gut möglich. Die Abschätzung der optimalen Tubuslage ist unter Bezugnahme auf anatomische Leitstrukturen mit den Ergebnissen der Röntgen-Thoraxaufnahme vergleichbar. Die Untersuchungstechnik ist für Ärztinnen und Ärzte mit Vorerfahrungen im Ultraschall geeignet. Erfolgversprechende Anwendungsgebiete des Point-of-care Ultrasound sind Notfall-Intubationen, der routinemäßige Einsatz bei Frühgeborenen mit extrem niedrigem Geburtsgewicht und in Ländern mit beschränkten Ressourcen. Zur Förderung des Bekanntheitsgrads und der klinischen Anwendung bietet dieser Artikel eine Praxisanleitung der Untersuchungstechnik.

Abstract

The reliable evaluation of a correctly placed endotracheal tube is an essential challenge in neonatology. Point-of-care ultrasound is an emerging method to address this concern with the following advantages: less time-consuming, no exposure to radiation, less staff-intensive, and high tolerability by the patients. This article focuses on the evaluation of the clinical application of point-of-care ultrasound to examine the position of the endotracheal tube with regard to visualization, consistency compared to the chest X-ray, and the level of training to obtain sufficient results. We identified nine studies relevant to these questions. The visualization of the endotracheal tube by using point-of-care ultrasound is highly effective. The assessment of a correctly placed endotracheal tube is comparable to the results of a chest X-ray. The technique is suitable for any examiner with previous ultrasound experience. Future applications such as emergency intubations, implementation in the standard care of extremely low birth weight preterm babies, and use in low-resource settings could be promising. This article offers a practical guideline to promote the level of awareness and the clinical application.

Schlüsselwörter

Intubation - Endotrachealtubus - Ultraschall - POCUS - Neugeborenes

Key words

intubation - endotracheal tube - ultrasound - POCUS - neonates


Publication History

Received: 26 October 2021

Accepted after revision: 29 December 2021

Article published online:
03 February 2022

© 2022. Thieme. All rights reserved.

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