Abstract：
Unrecognised oesophageal intubation causes preventable serious harm to patients undergoing tracheal intubation. When capnography is unavailable or doubted, clinicians still use clinical findings to confirm tracheal intubation, or exclude oesophageal intubation, and false reassurance from clinical examination is a recurring theme in fatal cases of unrecognised oesophageal intubation. We conducted a systematic review and meta-analysis of the diagnostic accuracy of five clinical examination tests and the oesophageal detector device when used to confirm tracheal intubation. We searched four databases for studies reporting index clinical tests against a reference standard, from inception to 28 February 2023. We included 49 studies involving 10,654 participants. Methodological quality was overall moderate to high. We looked at misting (three studies, 115 participants); lung auscultation (three studies, 217 participants); combined lung and epigastric auscultation (four studies, 506 participants); the oesophageal detector device (25 studies, 3024 participants); \'hang-up\' (two non-human studies); and chest rise (one non-human study). The reference standards used were capnography (22 studies); direct vision (10 studies); and bronchoscopy (three studies). When used to confirm tracheal intubation, misting has a false positive rate (95%CI) of 0.69 (0.43-0.87); lung auscultation 0.14 (0.08-0.23); five-point auscultation 0.18 (0.08-0.36); and the oesophageal detector device 0.05 (0.02-0.09). Tests to exclude events that invariably lead to severe damage or death must have a negligible false positive rate. Misting or auscultation have too high a false positive rate to reliably exclude oesophageal intubation and there is insufficient evidence to support the use of \'hang-up\' or chest rise. The oesophageal detector device may be considered where other more reliable means are not available, though waveform capnography remains the reference standard for confirmation of tracheal intubation.
摘要：
未被识别的食管插管会对接受气管插管的患者造成可预防的严重伤害。当二氧化碳监测不可用或怀疑时，临床医生仍然使用临床发现来确认气管插管，或者排除食管插管,在无法识别的食道插管的致命病例中，临床检查的错误保证是一个反复出现的主题。我们对五种临床检查测试和食管检测器用于确认气管插管的诊断准确性进行了系统回顾和荟萃分析。我们搜索了四个数据库，用于报告针对参考标准的指标临床试验的研究，从成立到2023年2月28日。我们纳入了49项研究，涉及10,654名参与者。方法学质量总体中等至较高。我们看了雾(三项研究，115名参与者)；肺听诊(三项研究，217名参与者)；联合肺和上腹部听诊(四项研究，506名参与者)；食道探测器(25项研究，3024名参与者）；“挂断”（两项非人类研究）；胸部上升（一项非人类研究）。使用的参考标准是二氧化碳描记术（22项研究）；直视（10项研究）；和支气管镜检查（三项研究）。当用于确认气管插管时，雾化的假阳性率（95CI）为0.69（0.43-0.87）；肺听诊0.14（0.08-0.23）；五点听诊0.18（0.08-0.36）；食道检测仪0.05（0.02-0.09）。排除总是导致严重损害或死亡的事件的测试必须具有可忽略的假阳性率。雾化或听诊的假阳性率过高，无法可靠地排除食管插管，并且没有足够的证据支持使用“挂断”或胸部上升。在没有其他更可靠装置的情况下，可以考虑食道检测器设备。尽管波形二氧化碳图仍然是确认气管插管的参考标准。
