Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois.
Advocate Christ Medical Center, Department of Emergency Medicine, Chicago, Illinois.
West J Emerg Med. 2018 Mar;19(2):412-416. doi: 10.5811/westjem.2017.12.36714. Epub 2018 Feb 22.
In the emergency department setting, it is essential to rapidly and accurately confirm correct endotracheal tube (ETT) placement. Ultrasound is an increasingly studied modality for identifying ETT location. However, there has been significant variation in techniques between studies, with some using the dynamic technique, while others use a static approach. This study compared the static and dynamic techniques to determine which was more accurate for ETT identification.
We performed this study in a cadaver lab using three different cadavers to represent variations in neck circumference. Cadavers were randomized to either tracheal or esophageal intubation in equal proportions. Blinded sonographers then assessed the location of the ETT using either static or dynamic sonography. We assessed accuracy of sonographer identification of ETT location, time to identification, and operator confidence.
A total of 120 intubations were performed: 62 tracheal intubations and 58 esophageal intubations. The static technique was 93.6% (95% confidence interval [CI] [84.3% to 98.2%]) sensitive and 98.3% specific (95% CI [90.8% to 99.9%]). The dynamic technique was 92.1% (95% CI [82.4% to 97.4%]) sensitive and 91.2% specific (95% CI [80.7% to 97.1%]). The mean time to identification was 6.72 seconds (95% CI [5.53 to 7.9] seconds) in the static technique and 6.4 seconds (95% CI [5.65 to 7.16] seconds) in the dynamic technique. Operator confidence was 4.9/5.0 (95% CI [4.83 to 4.97]) in the static technique and 4.86/5.0 (95% CI [4.78 to 4.94]) in the dynamic technique. There was no statistically significant difference between groups for any of the outcomes.
This study demonstrated that both the static and dynamic sonography approaches were rapid and accurate for confirming ETT location with no statistically significant difference between modalities. Further studies are recommended to compare these techniques in ED patients and with more novice sonographers.
在急诊科环境中，快速准确地确认正确的气管内管（ETT）位置至关重要。超声是一种越来越多地用于识别 ETT 位置的研究手段。然而，不同研究之间的技术存在显著差异，一些研究使用动态技术，而另一些研究则使用静态方法。本研究比较了静态和动态技术，以确定哪种方法更准确地识别 ETT。
我们在一个尸体实验室进行了这项研究，使用三个不同的尸体来代表颈部周长的变化。尸体随机分为气管插管或食管插管，比例相等。盲法超声医师然后使用静态或动态超声评估 ETT 的位置。我们评估了超声医师对 ETT 位置的识别准确性、识别时间和操作者信心。
共进行了 120 次插管：62 次气管插管和 58 次食管插管。静态技术的敏感性为 93.6%（95%置信区间[CI] [84.3%至 98.2%]），特异性为 98.3%（95%CI [90.8%至 99.9%]）。动态技术的敏感性为 92.1%（95%CI [82.4%至 97.4%]），特异性为 91.2%（95%CI [80.7%至 97.1%]）。静态技术的平均识别时间为 6.72 秒（95%CI [5.53 秒至 7.9 秒]），动态技术为 6.4 秒（95%CI [5.65 秒至 7.16 秒]）。静态技术的操作者信心为 4.9/5.0（95%CI [4.83 至 4.97]），动态技术为 4.86/5.0（95%CI [4.78 至 4.94]）。在任何结果中，两组之间均无统计学意义上的差异。
本研究表明，静态和动态超声方法都可以快速准确地确认 ETT 位置，两种方法之间无统计学意义上的差异。建议进一步研究比较这些技术在急诊科患者和更初级超声医师中的应用。
