Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
Am J Emerg Med. 2023 Dec;74:17-20. doi: 10.1016/j.ajem.2023.09.014. Epub 2023 Sep 17.
After endotracheal intubation is performed, the location of the endotracheal tube (ETT) is confirmed followed by assessment of ETT depth. Physical examination can be unreliable and chest radiographs can lead to delayed recognition. Ultrasound may facilitate rapid determination of ETT depth at the bedside; however, the ideal technique is unknown.
This was a randomized trial comparing the static versus dynamic technique for ETT depth assessment using a cadaver model. The ETT was randomized to correct versus deep placement. Seven physicians blinded to ETT location assessed the location using static (direct visualization of an inflated cuff) versus dynamic (active inflation of the ETT cuff) visualization. Outcomes included diagnostic accuracy, time to identification, and operator confidence with subgroup analyses by physician ultrasound experience.
420 total assessments were performed. The static technique was 99.1% (95% CI 94.8%-100%) sensitive and 97.1% (95% CI 91.9%-99.4%) specific. The dynamic technique was 100% (95% CI 96.7%-100%) sensitive and 100% (95% CI 96.7%-100%) specific. Time to identification was faster for the static technique (6.6 s; 95% CI 5.9-7.4 s) versus the dynamic technique (8.7 s; 95% CI 8.0-9.5 s). Operator confidence was lower for the static technique (4.4/5.0; 95% CI 4.3-4.5) versus the dynamic technique (4.7/5.0; 95% CI 4.6-4.8). There were no differences in the findings when assessed among expert or non-expert sonographers.
There was no statistically significant difference in the accuracy of ETT depth identification between the static or dynamic technique. However, utilizing the dynamic technique showed a statistically significant improvement in sonographer confidence and a concomitant increase in time to identification.
气管插管后，需确认气管导管（ETT）的位置，然后评估 ETT 深度。体格检查可能不可靠，胸部 X 线片可能导致识别延迟。超声检查可在床边快速确定 ETT 深度；然而，理想的技术尚不清楚。
这是一项在尸体模型中比较使用静态和动态技术评估 ETT 深度的随机试验。将 ETT 随机放置在正确位置或过深位置。7 名对 ETT 位置不知情的医生使用静态（充气套囊的直接可视化）和动态（主动充气 ETT 套囊）可视化方法评估位置。结果包括诊断准确性、识别时间和操作员信心，并有亚组分析按医生超声经验。
共进行了 420 次总评估。静态技术的敏感性为 99.1%（95%置信区间 94.8%-100%），特异性为 97.1%（95%置信区间 91.9%-99.4%）。动态技术的敏感性为 100%（95%置信区间 96.7%-100%），特异性为 100%（95%置信区间 96.7%-100%）。静态技术的识别时间更快（6.6 秒；95%置信区间 5.9-7.4 秒），而动态技术的识别时间更长（8.7 秒；95%置信区间 8.0-9.5 秒）。静态技术的操作员信心较低（4.4/5.0；95%置信区间 4.3-4.5），而动态技术的操作员信心较高（4.7/5.0；95%置信区间 4.6-4.8）。在专家和非专家超声医师中评估时，结果没有差异。
静态或动态技术在 ETT 深度识别的准确性方面没有统计学差异。然而，使用动态技术在超声医师信心方面显示出统计学上的显著改善，同时识别时间也相应增加。
