472
Correspondence / American Journal of Emergency Medicine 32 (2014) 466–485
References [1] Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R. BEAUTIFUL investigators. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomized controlled trial. Lancet 2008;372:817–21. [2] Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L. SHIFT investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled study. Lancet 2010;376:875–85. [3] Steg P., Lopez-de-Sà E., Schiele F., Hamon M., Meinertz T., Goicolea J., Werdan K., Lopez-Sendon J.L.; VIVIFY (eValuation of the IntraVenous If inhibitor ivabradine after STsegment elevation mYocardial infarction) investigators. Safety of intravenous ivabradine in acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a randomized, placebocontrolled, double-blind, pilot study. Eur Heart J Acute Cardiovasc Care. 2013; 2: 270–9. [4] De Santis V, Vitale D, Santoro A, Magliocca A, Porto AG, Nencini C, Tritapepe L. Ivabradine: potential clinical applications in critically ill patients. Clin Res Cardiol 2013;102:171–8. [5] McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2012;14: 803–69. [6] Castagno D, Petrie MC, Claggett B, McMurray J. Should we SHIFT our thinking about digoxin? Observations on ivabradine and heart rate reduction in heart failure. Eur Heart J 2012;33:1137–41. [7] Kondrat'ev AI, Dolgikh VT, Stotskiĭ AO. Efficacy of ivabradine in combination therapy for complicated acute coronary syndrome in patients with type 2 diabetes mellitus. Ter Arkh 2010;82(1):27–31. [8] Link A, Reil JC, Selejan S, Böhm M. Effect of ivabradine in dobutamine induced sinus tachycardia in a case of acute heart failure. Clin Res Cardiol 2009;98:513–5. [9] Arutiunov GP, Arutiunov AG, Volkova AL. Study evaluating the impact of a combination of inotropic support and heart rate control on prognosis and stabilization rate in patients with decompensated chronic heart failure (LEGION). Ter Arkh 2010;82:47–52.
Does ultrasonographic lung sliding sign always verify the success in endotracheal tube intubation?☆
ETT. The lung ultrasound performed during ventilation with bag valve mask revealed pleural sliding movement, but the amount of end tidal CO2 did not confirm the success of ETI via simultaneous capnography. The patient was extubated and reintubuated again. Correct ETT placement was confirmed via auscultation, capnography, and presence of sliding movement. Thorax computed tomography had revealed no pneumothorax in both lungs [8]. Correct ETT placement can be confirmed by means of ultrasonographic pleural sliding in patients with provided advanced airway. Pleural sliding movement may cause false negativity in some cases such as patients with subcutaneous emphysema or bilateral pneumothorax. In addition, it may cause false positivity in patients with esophageal intubation due to increase of thoracic pressure induced by increased air in stomach as well as in the reported case.
Umit Kaldirim, MD Salim Kemal Tuncer, MD Yusuf Emrah Eyi, MD Department of Emergency Medicine Gulhane Military Medical Academy School of Medicine Ankara, Turkey Yakup Aksoy MD Department of Ophthalmology Hakkari Military Hospital Hakkari, Turkey E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.01.021 References
To the Editor, We read with a great interest the article, “Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital” written by Brun et al [1]. We appreciate the authors sharing their enlightening study with us. We believe that their article will lead to many studies confirming the success of endotracheal intubation (ETI). The authors reported to determine the success of ETI in 52-year-old female patient presenting cardiorespiratory failure by ultrasound revealing bilateral pleural sliding and the method to be applicable and useful. We aim to draw attention to pleural sliding that could lead to false positivity. Confirmation of correct endotracheal tube (ETT) placement is a notably critical procedure for emergency physicians. Although there are variety of methods to confirm the success of ETI, none of them are ideal [2]. Capnometry and evaluation of breath sounds are commonly used methods in daily practice [3,4]. Postintubation chest radiography is deemed to be among these methods [5]. Recently, several studies have shown that bilateral pleural sliding movement seen in the T mode of ultrasound also is highly successful in demonstrating the success of endotracheal intubation and has particularly considerable time advantage of ultrasound over chest radiography [6,7]. Although this method has favorable outcomes, recognizing such situations providing false-positive and falsenegative results are crucial. In a recent published article, a case of a 47-year-old male patient was reported who was presented with cardiorespiratory failure due to in-car traffic accident. The authors noted that the patient’s breath sounds could not be heard in a desired quality after intubation with
☆ We have no support in financial or other relationships that might lead to a conflict of interest.
[1] Brun PM, Bessereau J, Cazes N, et al. Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital. Am J Emerg Med 2012;30:2080. [2] Adi O, Chuan TW, Rishya M. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation. Crit Ultrasound J 2013;5:7. [3] Singh S, Allen Jr WD, Venkataraman ST, et al. Utility of a novel quantitative handheld microstream capnometer during transport of critically ill children. Am J Emerg Med 2006;24:302–7. [4] Xue FS, Yuan YJ, Wang Q, et al. Comments on tracheal intubation using Macintosh and video laryngoscopes during chest compressions. Am J Emerg Med 2011;29:126–7. [5] Hossein-Nejad H, Payandemehr P, Bashiri SA, et al. Chest radiography after endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31:1181–2. [6] Sağlam C, Unlüer EE, Karagöz A. Confirmation of endotracheal tube position during resuscitation by bedside ultrasonography. Am J Emerg Med 2013;31:248–50. [7] Sim SS, Lien WC, Chou HC, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation. Resuscitation 2012;83:307–12. [8] Kaldırım U., Tuncer S.K., Eyi Y.E. False positivity of ultrasonographic lung sliding sign while verifying success in endotracheal tube positioning. J Clin Anal Med. Epub 2013 Dec 13.
Comparing performance of video and direct laryngoscopes for intubation during prehospital cardiopulmonary resuscitation☆ To the Editor, The recent article by Arima et al [1] comparing the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (MLS) for tracheal intubation in 109 prehospital patients with primarily cardiac arrest was of great interest to us. They found that the AWS did not show
☆ Statement: All authors have no financial support and potential conflicts of interest for this work.
Correspondence / American Journal of Emergency Medicine 32 (2014) 466–485
References [1] Fox K, Ford I, Steg PG, Tendera M, Robertson M, Ferrari R. BEAUTIFUL investigators. Heart rate as a prognostic risk factor in patients with coronary artery disease and left-ventricular systolic dysfunction (BEAUTIFUL): a subgroup analysis of a randomized controlled trial. Lancet 2008;372:817–21. [2] Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L. SHIFT investigators. Ivabradine and outcomes in chronic heart failure (SHIFT): a randomized placebo-controlled study. Lancet 2010;376:875–85. [3] Steg P., Lopez-de-Sà E., Schiele F., Hamon M., Meinertz T., Goicolea J., Werdan K., Lopez-Sendon J.L.; VIVIFY (eValuation of the IntraVenous If inhibitor ivabradine after STsegment elevation mYocardial infarction) investigators. Safety of intravenous ivabradine in acute ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention: a randomized, placebocontrolled, double-blind, pilot study. Eur Heart J Acute Cardiovasc Care. 2013; 2: 270–9. [4] De Santis V, Vitale D, Santoro A, Magliocca A, Porto AG, Nencini C, Tritapepe L. Ivabradine: potential clinical applications in critically ill patients. Clin Res Cardiol 2013;102:171–8. [5] McMurray JJ, Adamopoulos S, Anker SD, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 2012;14: 803–69. [6] Castagno D, Petrie MC, Claggett B, McMurray J. Should we SHIFT our thinking about digoxin? Observations on ivabradine and heart rate reduction in heart failure. Eur Heart J 2012;33:1137–41. [7] Kondrat'ev AI, Dolgikh VT, Stotskiĭ AO. Efficacy of ivabradine in combination therapy for complicated acute coronary syndrome in patients with type 2 diabetes mellitus. Ter Arkh 2010;82(1):27–31. [8] Link A, Reil JC, Selejan S, Böhm M. Effect of ivabradine in dobutamine induced sinus tachycardia in a case of acute heart failure. Clin Res Cardiol 2009;98:513–5. [9] Arutiunov GP, Arutiunov AG, Volkova AL. Study evaluating the impact of a combination of inotropic support and heart rate control on prognosis and stabilization rate in patients with decompensated chronic heart failure (LEGION). Ter Arkh 2010;82:47–52.
Does ultrasonographic lung sliding sign always verify the success in endotracheal tube intubation?☆
ETT. The lung ultrasound performed during ventilation with bag valve mask revealed pleural sliding movement, but the amount of end tidal CO2 did not confirm the success of ETI via simultaneous capnography. The patient was extubated and reintubuated again. Correct ETT placement was confirmed via auscultation, capnography, and presence of sliding movement. Thorax computed tomography had revealed no pneumothorax in both lungs [8]. Correct ETT placement can be confirmed by means of ultrasonographic pleural sliding in patients with provided advanced airway. Pleural sliding movement may cause false negativity in some cases such as patients with subcutaneous emphysema or bilateral pneumothorax. In addition, it may cause false positivity in patients with esophageal intubation due to increase of thoracic pressure induced by increased air in stomach as well as in the reported case.
Umit Kaldirim, MD Salim Kemal Tuncer, MD Yusuf Emrah Eyi, MD Department of Emergency Medicine Gulhane Military Medical Academy School of Medicine Ankara, Turkey Yakup Aksoy MD Department of Ophthalmology Hakkari Military Hospital Hakkari, Turkey E-mail address: [email protected] http://dx.doi.org/10.1016/j.ajem.2014.01.021 References
To the Editor, We read with a great interest the article, “Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital” written by Brun et al [1]. We appreciate the authors sharing their enlightening study with us. We believe that their article will lead to many studies confirming the success of endotracheal intubation (ETI). The authors reported to determine the success of ETI in 52-year-old female patient presenting cardiorespiratory failure by ultrasound revealing bilateral pleural sliding and the method to be applicable and useful. We aim to draw attention to pleural sliding that could lead to false positivity. Confirmation of correct endotracheal tube (ETT) placement is a notably critical procedure for emergency physicians. Although there are variety of methods to confirm the success of ETI, none of them are ideal [2]. Capnometry and evaluation of breath sounds are commonly used methods in daily practice [3,4]. Postintubation chest radiography is deemed to be among these methods [5]. Recently, several studies have shown that bilateral pleural sliding movement seen in the T mode of ultrasound also is highly successful in demonstrating the success of endotracheal intubation and has particularly considerable time advantage of ultrasound over chest radiography [6,7]. Although this method has favorable outcomes, recognizing such situations providing false-positive and falsenegative results are crucial. In a recent published article, a case of a 47-year-old male patient was reported who was presented with cardiorespiratory failure due to in-car traffic accident. The authors noted that the patient’s breath sounds could not be heard in a desired quality after intubation with
☆ We have no support in financial or other relationships that might lead to a conflict of interest.
[1] Brun PM, Bessereau J, Cazes N, et al. Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital. Am J Emerg Med 2012;30:2080. [2] Adi O, Chuan TW, Rishya M. A feasibility study on bedside upper airway ultrasonography compared to waveform capnography for verifying endotracheal tube location after intubation. Crit Ultrasound J 2013;5:7. [3] Singh S, Allen Jr WD, Venkataraman ST, et al. Utility of a novel quantitative handheld microstream capnometer during transport of critically ill children. Am J Emerg Med 2006;24:302–7. [4] Xue FS, Yuan YJ, Wang Q, et al. Comments on tracheal intubation using Macintosh and video laryngoscopes during chest compressions. Am J Emerg Med 2011;29:126–7. [5] Hossein-Nejad H, Payandemehr P, Bashiri SA, et al. Chest radiography after endotracheal tube placement: is it necessary or not? Am J Emerg Med 2013;31:1181–2. [6] Sağlam C, Unlüer EE, Karagöz A. Confirmation of endotracheal tube position during resuscitation by bedside ultrasonography. Am J Emerg Med 2013;31:248–50. [7] Sim SS, Lien WC, Chou HC, et al. Ultrasonographic lung sliding sign in confirming proper endotracheal intubation during emergency intubation. Resuscitation 2012;83:307–12. [8] Kaldırım U., Tuncer S.K., Eyi Y.E. False positivity of ultrasonographic lung sliding sign while verifying success in endotracheal tube positioning. J Clin Anal Med. Epub 2013 Dec 13.
Comparing performance of video and direct laryngoscopes for intubation during prehospital cardiopulmonary resuscitation☆ To the Editor, The recent article by Arima et al [1] comparing the Pentax-AWS Airwayscope (AWS) and Macintosh laryngoscope (MLS) for tracheal intubation in 109 prehospital patients with primarily cardiac arrest was of great interest to us. They found that the AWS did not show
☆ Statement: All authors have no financial support and potential conflicts of interest for this work.
