经胸超声心动图在儿童中心静脉导管尖端定位中的应用:经食管超声心动图作为参考方法的观察性研究。

IF 1.7 4区 医学 Q2 ANESTHESIOLOGY
Pediatric Anesthesia Pub Date : 2025-04-01 Epub Date: 2025-01-04 DOI:10.1111/pan.15059
Kristen K Thomsen, Michael Fritz, Christian Zöllner, Till Kessler, Bernd Saugel, Leonie Schulte-Uentrop
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引用次数: 0

摘要

背景:需要进行大手术或危重儿童通常需要插入中心静脉导管(CVC)。为了避免严重的并发症,将CVC尖端正确定位在远上腔静脉与右心房的交界处(腔房交界处)是很重要的。经胸超声心动图(TTE)可用于确定CVC尖端的正确位置。然而,TTE对CVC尖端定位的准确性主要是用胸部x线作为参考方法来研究的,尽管胸部x线本身不能直接定位CVC尖端在腔房交界处。目的:我们的目的是确定在儿童CVC插入时,TTE是否可以帮助CVC尖端精确定位在腔房交界处。我们特别验证了这样的假设:在≥90%的儿童中,te引导的CVC尖端定位结果是在腔房交界处正确的CVC尖端位置(经食管超声心动图(TEE)作为参考方法证实)。方法:这是一项前瞻性观察研究,研究对象为0-14岁计划择期手术治疗先天性心脏病的儿童。我们的主要终点是通过TEE确认的TTE引导导致CVC尖端正确位置在腔房交界处的儿童比例。结果:对150例患儿进行分析。tte引导下CVC尖端定位136例患儿(91%,95%可信区间:85%-94%),CVC尖端正确定位于腔房交界处。TTE指导导致CVC尖端正确位置在腔房交界处的儿童比例在0-3月龄儿童中最高(96%),在13-14岁儿童中最低(70%)。结论:在91%的儿童中,tte引导的CVC尖端定位导致CVC尖端在腔房交界处的正确位置,TEE证实了这一点。临床医生应考虑在儿童,特别是年幼儿童的CVC插入时,使用TTE将CVC尖端定位在腔房交界处。试验注册:德国临床试验注册:DRKS00028271。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Transthoracic Echocardiography for Central Venous Catheter Tip Positioning in Children: An Observational Study Using Transesophageal Echocardiography as Reference Method.

Background: Children who need to have major surgery or are critically ill often require the insertion of a central venous catheter (CVC). To avoid serious complications, it is important to correctly position the CVC tip at the junction of the distal superior vena cava and the right atrium (cavoatrial junction). Transthoracic echocardiography (TTE) can be used to confirm the correct position of the CVC tip. However, the accuracy of TTE for CVC tip positioning has mainly been investigated using chest X-ray as the reference method-although chest X-ray itself does not allow directly locating the CVC tip at the cavoatrial junction.

Aims: We aimed to determine if TTE can help exactly position the CVC tip at the cavoatrial junction during CVC insertion in children. We specifically tested the hypothesis that TTE-guided CVC tip positioning results in a correct CVC tip position at the cavoatrial junction (confirmed by transesophageal echocardiography (TEE) as the reference method) in ≥ 90% of the children.

Methods: This was a prospective observational study in children aged 0-14 years scheduled for elective surgery for congenital heart disease. Our primary endpoint was the proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE.

Results: 150 children were analyzed. TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction in 136 children (91%, 95% confidence interval: 85%-94%). The proportion of children in whom TTE guidance resulted in a correct CVC tip position at the cavoatrial junction was highest in children aged 0-3 months (96%) and lowest in children aged 13-14 years (70%).

Conclusion: TTE-guided CVC tip positioning resulted in a correct CVC tip position at the cavoatrial junction, confirmed by TEE, in 91% of children. Clinicians should consider using TTE to position the CVC tip at the cavoatrial junction during CVC insertion in children-particularly younger children.

Trial registration: German Clinical Trial Register: DRKS00028271.

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来源期刊
Pediatric Anesthesia
Pediatric Anesthesia 医学-麻醉学
CiteScore
3.20
自引率
11.80%
发文量
222
审稿时长
3-8 weeks
期刊介绍: Devoted to the dissemination of research of interest and importance to practising anesthetists everywhere, the scientific and clinical content of Pediatric Anesthesia covers a wide selection of medical disciplines in all areas relevant to paediatric anaesthesia, pain management and peri-operative medicine. The International Editorial Board is supported by the Editorial Advisory Board and a team of Senior Advisors, to ensure that the journal is publishing the best work from the front line of research in the field. The journal publishes high-quality, relevant scientific and clinical research papers, reviews, commentaries, pro-con debates, historical vignettes, correspondence, case presentations and book reviews.
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