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

El 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 sensibi...

Full description

Autores:
Ardila Torres, Luis Guillermo
Tipo de recurso:
Fecha de publicación:
2020
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/7158
Acceso en línea:
http://hdl.handle.net/20.500.12749/7158
Palabra clave:
Anesthesiology
Medical sciences
Health sciences
Medicine
Airway management
Intratracheal intubation
Ultrasonography
Pediatrics
Ultrasound
Ultrasonic diagnosis
Pediatric intensive care
Anestesiología
Ciencias médicas
Medicina
Ecografía
Diagnóstico ultrasónico
Cuidados intensivos pediátricos
Ciencias de la salud
Manejo de la vía aérea
Intubación intratraqueal
Ultrasonografía
Pediatría
Rights
openAccess
License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_d7de17589fbd75768bebd24485220e97
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/7158
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
dc.title.translated.eng.fl_str_mv Ultrasonographic evaluation of the positioning of the endotracheal tube in the pediatric population (pilot study)
title Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
spellingShingle Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
Anesthesiology
Medical sciences
Health sciences
Medicine
Airway management
Intratracheal intubation
Ultrasonography
Pediatrics
Ultrasound
Ultrasonic diagnosis
Pediatric intensive care
Anestesiología
Ciencias médicas
Medicina
Ecografía
Diagnóstico ultrasónico
Cuidados intensivos pediátricos
Ciencias de la salud
Manejo de la vía aérea
Intubación intratraqueal
Ultrasonografía
Pediatría
title_short Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
title_full Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
title_fullStr Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
title_full_unstemmed Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
title_sort Valoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)
dc.creator.fl_str_mv Ardila Torres, Luis Guillermo
dc.contributor.advisor.spa.fl_str_mv Rodríguez Gómez, Ciro Alfonso
Meléndez Flórez, Héctor Julio
dc.contributor.author.spa.fl_str_mv Ardila Torres, Luis Guillermo
dc.contributor.cvlac.*.fl_str_mv https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609
dc.contributor.orcid.*.fl_str_mv https://orcid.org/0000-0003-1791-8099
dc.subject.keywords.eng.fl_str_mv Anesthesiology
Medical sciences
Health sciences
Medicine
Airway management
Intratracheal intubation
Ultrasonography
Pediatrics
Ultrasound
Ultrasonic diagnosis
Pediatric intensive care
topic Anesthesiology
Medical sciences
Health sciences
Medicine
Airway management
Intratracheal intubation
Ultrasonography
Pediatrics
Ultrasound
Ultrasonic diagnosis
Pediatric intensive care
Anestesiología
Ciencias médicas
Medicina
Ecografía
Diagnóstico ultrasónico
Cuidados intensivos pediátricos
Ciencias de la salud
Manejo de la vía aérea
Intubación intratraqueal
Ultrasonografía
Pediatría
dc.subject.lemb.spa.fl_str_mv Anestesiología
Ciencias médicas
Medicina
Ecografía
Diagnóstico ultrasónico
Cuidados intensivos pediátricos
dc.subject.proposal.spa.fl_str_mv Ciencias de la salud
Manejo de la vía aérea
Intubación intratraqueal
Ultrasonografía
Pediatría
description El 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.
publishDate 2020
dc.date.accessioned.none.fl_str_mv 2020-08-05T16:19:16Z
dc.date.available.none.fl_str_mv 2020-08-05T16:19:16Z
dc.date.issued.none.fl_str_mv 2020-06-30
dc.type.driver.none.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.redcol.none.fl_str_mv http://purl.org/redcol/resource_type/TM
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/7158
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
url http://hdl.handle.net/20.500.12749/7158
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv 1. 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.
2. Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand. 2011;55(10):1155–73.
3. 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
4. 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.
5. 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
6. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Paediatr Anaesth. 2006;16(12):1238–43.
7. 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
8. 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.
9. 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.
10. 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.
11. 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.
12. 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
13. 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
14. 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
15. 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
16. 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
17. 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.
18. 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
19. 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.
20. 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.
21. 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
22. 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.
23. 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.
24. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369–73.
25. 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.
26. 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.
27. 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
28. 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
29. 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.
30. 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.
31. 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
32. 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.
33. 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
34. 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
35. 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
36. 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
37. 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.
38. 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
39. 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
40. 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.
41. 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
42. 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.
43. 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.
44. 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
45. 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
46. Stafrace S, Engelhardt T, Teoh WH, Kristensen MS. Essential ultrasound techniques of the pediatric airway. Pediatr Anesth. 2016;26(2):122–31.
47. 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.
48. Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: point of care in children – the time is now. Pediatr Anesth. 2020;0(0):1–6.
49. 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
50. 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
51. 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.
52. 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.
53. 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.
54. 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.
55. 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.
56. 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
57. 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.
58. 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.
59. 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/
60. 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.rights.uri.*.fl_str_mv http://creativecommons.org/licenses/by-nc-nd/2.5/co/
dc.rights.local.spa.fl_str_mv Abierto (Texto Completo)
dc.rights.accessrights.spa.fl_str_mv info:eu-repo/semantics/openAccess
http://purl.org/coar/access_right/c_abf2
dc.rights.creativecommons.*.fl_str_mv Atribución-NoComercial-SinDerivadas 2.5 Colombia
rights_invalid_str_mv http://creativecommons.org/licenses/by-nc-nd/2.5/co/
Abierto (Texto Completo)
http://purl.org/coar/access_right/c_abf2
Atribución-NoComercial-SinDerivadas 2.5 Colombia
eu_rights_str_mv openAccess
dc.format.mimetype.spa.fl_str_mv application/pdf
dc.coverage.spatial.spa.fl_str_mv Bucaramanga (Santander, Colombia)
dc.publisher.grantor.spa.fl_str_mv Universidad Autónoma de Bucaramanga UNAB
dc.publisher.faculty.spa.fl_str_mv Facultad Ciencias de la Salud
dc.publisher.program.spa.fl_str_mv Especialización en Anestesiología
institution Universidad Autónoma de Bucaramanga - UNAB
bitstream.url.fl_str_mv https://repository.unab.edu.co/bitstream/20.500.12749/7158/1/2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf
https://repository.unab.edu.co/bitstream/20.500.12749/7158/2/2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf
https://repository.unab.edu.co/bitstream/20.500.12749/7158/3/license.txt
https://repository.unab.edu.co/bitstream/20.500.12749/7158/4/2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf.jpg
https://repository.unab.edu.co/bitstream/20.500.12749/7158/5/2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf.jpg
bitstream.checksum.fl_str_mv d62b7abeaef0ca3b447e6d48df50df3a
85c76330f20b62c92a3aff615e9f5221
8a4605be74aa9ea9d79846c1fba20a33
1320a76672e8b97dc2c1d53114c42db6
480cbf4a627b59ff2d6516ea68d90784
bitstream.checksumAlgorithm.fl_str_mv MD5
MD5
MD5
MD5
MD5
repository.name.fl_str_mv Repositorio Institucional | Universidad Autónoma de Bucaramanga - UNAB
repository.mail.fl_str_mv repositorio@unab.edu.co
_version_ 1808410710455091200
spelling Rodríguez Gómez, Ciro Alfonso6f603c3c-e5b0-49af-a662-ed3b02eb159eMeléndez Flórez, Héctor Julio20cc143a-86c7-44c4-bcab-57fb40719b36Ardila Torres, Luis Guillermo18c9ed75-37cc-452d-8508-30f7bd2824d8https://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000320609https://orcid.org/0000-0003-1791-8099Bucaramanga (Santander, Colombia)2020-08-05T16:19:16Z2020-08-05T16:19:16Z2020-06-30http://hdl.handle.net/20.500.12749/7158instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.coEl 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.1. INFORMACIÓN GENERAL DEL PROYECTO DE INVESTIGACIÓN ................................ 4 2. INTRODUCCIÓN ......................................................................................................................... 6 3. PLANTEAMIENTO DEL PROBLEMA ..................................................................................... 7 3.1 PREGUNTA DE INVESTIGACIÓN ........................................................................................9 3.2 HIPÓTESIS INVESTIGATIVA ...............................................................................................9 4. MARCO TEÓRICO .....................................................................................................................9 5. OBJETIVOS .............................................................................................................................. 30 5.1 OBJETIVO GENERAL .......................................................................................................... 30 5.2 OBJETIVOS ESPECÍFICOS .................................................................................................. 31 5. METODOLOGÍA ........................................................................................................................ 31 5.1 Tipo de estudio ................................................................................................................... 31 5.2 Diseño Muestral ................................................................................................................. 31 5.3 Población Elegible ............................................................................................................. 32 5.4 Criterios de selección ....................................................................................................... 32 5.4.1 Criterios de inclusión: ...............................................................................................................................32 5.4.2 Criterios de exclusión: ..............................................................................................................................32 5.5 Variables Resultado (Ver anexo 1). .............................................................................. 33 5.5.1 Variable de Resultado: ..............................................................................................................................33 5.5.2 Variables Independientes: Ver Anexo 1. .............................................................................................35 5.8 Métodos para el control de calidad de los datos ....................................................... 37 5.9 Análisis de los datos .......................................................................................................... 37 5.10 Medidas de Bioseguridad. ............................................................................................. 39 6. CONSIDERACIONES ÉTICAS ................................................................................................. 41 7. IMPACTOS Y PRODUCTOS ESPERADOS ........................................................................... 42 8. CRONOGRAMA DE ACTIVIDADES ...................................................................................... 43 9. PRESUPUESTO.......................................................................................................................... 46 10. RESULTADOS .......................................................................................................................... 47 11. DISCUSIÓN .............................................................................................................................. 53 12. BIBLIOGRAFÍA ....................................................................................................................... 56 13. ANEXOS .................................................................................................................................... 64 13.1 ANEXO 1 ............................................................................................................................. 64 13.2 ANEXO 2 ............................................................................................................................. 67 13.3 ANEXO 3 ............................................................................................................................. 70EspecializaciónSummary: The purpose of the present study is to evaluate the usefulness of ultrasound as a diagnostic tool to determine the bad positioning of the endotracheal tube (TET) in the pediatric population, since its reported incidence is 30-50%. Our hypothesis inferred that ultrasound has a sensitivity and specificity greater than 90% to establish malposition. Methods: A prospective sample was collected from patients who were intubated to receive ventilatory support in the Neonatal Intensive Care Unit, after endorsement by informed consent, the ultrasound evaluation was performed and subsequent comparison with the chest x-ray. The primary outcome was to determine the concordance of endotracheal tube mispositioning from ultrasound examination and chest radiography. Results: The incidence of TET malposition in 14 evaluated intubation events was 35.6%, the sensitivity to determine malposition by ultrasound was 40%, the specificity and the positive predictive value of 100% and a negative predictive value of 75 %. Conclusions: Ultrasound is a useful tool to determine an eventual endotracheal tube malposition, supported by its high specificity and high positive predictive value. However, the ultrasound signs that determine a correct positioning are not enough to determine its proper position, therefore it is necessary to confirm it with the chest radiography. Taking into account the low representability of the sample of the present study, studies with a greater sample size are required in order to clarify the knowledge on the diagnostic performance of ultrasound as a tool to determine its correct or incorrect TET position.application/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-SinDerivadas 2.5 ColombiaValoración ecográfica del posicionamiento del tubo endotraqueal en población pediátrica (Estudio piloto)Ultrasonographic evaluation of the positioning of the endotracheal tube in the pediatric population (pilot study)Especialista en AnestesiologíaUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludEspecialización en Anestesiologíainfo:eu-repo/semantics/masterThesisTesishttp://purl.org/redcol/resource_type/TMAnesthesiologyMedical sciencesHealth sciencesMedicineAirway managementIntratracheal intubationUltrasonographyPediatricsUltrasoundUltrasonic diagnosisPediatric intensive careAnestesiologíaCiencias médicasMedicinaEcografíaDiagnóstico ultrasónicoCuidados intensivos pediátricosCiencias de la saludManejo de la vía aéreaIntubación intratraquealUltrasonografíaPediatría1. 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):125–31.2. Kristensen MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand. 2011;55(10):1155–73.3. 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.2015.02.0134. 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):1111–7.5. 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.2014.2406. Lau N, Playfor SD, Rashid A, Dhanarass M. New formulae for predicting tracheal tube length. Paediatr Anaesth. 2006;16(12):1238–43.7. 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.00000000000010738. 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):23–9.9. 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):685–90.10. 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):1143.11. 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):S526–42.12. 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-live13. 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.2016.01.03114. 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.2017.10.00115. 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.2012.11.02816. 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/pdf17. 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;82:251–3.18. 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.x19. 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):486–91.20. 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. 1167–85.21. 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/10.1080/14767058.2017.140358122. 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):393–7.23. 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):138–42.24. Kempley ST, Moreiras JW, Petrone FL. Endotracheal tube length for neonatal intubation. Resuscitation. 2008;77(3):369–73.25. 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):243–7.26. 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):303–8.27. 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/B978-0-323-42974-0.00014-828. 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/B978-0-323-34125-7.00018-829. 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):115–21.30. 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):2871–6.31. 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 ull32. 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):S51–60.33. 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.pdf34. 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.2016.07.01935. 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/full36. 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.pdf37. 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):7–14.38. 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.2008-282839. 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.2014.01.00440. 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):413–23.41. 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=YES42. Vijaykumar R, Saboo AR. Review of Different Methods Used for Confirmation of Endotracheal Tube Placement in Newborns. J Neonatal Biol. 2014;3(4):2–5.43. Kristensen MS, Teoh WH, Rudolph SS. Ultrasonographic identification of the cricothyroid membrane: Best evidence, techniques, and clinical impact. Br J Anaesth. 2016;117(S1):i39–48.44. 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 3e3182746a3045. 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.2006-295946. Stafrace S, Engelhardt T, Teoh WH, Kristensen MS. Essential ultrasound techniques of the pediatric airway. Pediatr Anesth. 2016;26(2):122–31.47. 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):253–79.48. Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: point of care in children – the time is now. Pediatr Anesth. 2020;0(0):1–6.49. 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.2014.08.03350. 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.2012.02.01351. 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):293–7.52. 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):461–5.53. 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):582–4.54. 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):e469–76.55. 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):10–6.56. 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.2019.03.02057. 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):456–62.58. 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):56–8.59. 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/60. 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.pdfORIGINAL2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf2019_Tesis_Luis_Guillermo_Ardila_Torres.pdfTesisapplication/pdf3323290https://repository.unab.edu.co/bitstream/20.500.12749/7158/1/2019_Tesis_Luis_Guillermo_Ardila_Torres.pdfd62b7abeaef0ca3b447e6d48df50df3aMD51open access2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf2019_Licencia_Luis_Guillermo_Ardila_Torres.pdfLicenciaapplication/pdf479605https://repository.unab.edu.co/bitstream/20.500.12749/7158/2/2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf85c76330f20b62c92a3aff615e9f5221MD52metadata only accessLICENSElicense.txtlicense.txttext/plain; charset=utf-81748https://repository.unab.edu.co/bitstream/20.500.12749/7158/3/license.txt8a4605be74aa9ea9d79846c1fba20a33MD53open accessTHUMBNAIL2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf.jpg2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf.jpgIM Thumbnailimage/jpeg4918https://repository.unab.edu.co/bitstream/20.500.12749/7158/4/2019_Tesis_Luis_Guillermo_Ardila_Torres.pdf.jpg1320a76672e8b97dc2c1d53114c42db6MD54open access2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf.jpg2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf.jpgIM Thumbnailimage/jpeg11000https://repository.unab.edu.co/bitstream/20.500.12749/7158/5/2019_Licencia_Luis_Guillermo_Ardila_Torres.pdf.jpg480cbf4a627b59ff2d6516ea68d90784MD55open access20.500.12749/7158oai:repository.unab.edu.co:20.500.12749/71582022-11-20 09:06:04.845open accessRepositorio Institucional | Universidad Autónoma de Bucaramanga - UNABrepositorio@unab.edu.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

Publicaciones similares