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Randomized Controlled Trial
. 2018 Mar;19(2):412-416.
doi: 10.5811/westjem.2017.12.36714. Epub 2018 Feb 22.

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Michael Gottlieb  1 , Damali Nakitende  2 , Tina Sundaram  1 , Anthony Serici  1 , Shital Shah  1   3 , John Bailitz  4
Affiliations
Randomized Controlled Trial

Comparison of Static versus Dynamic Ultrasound for the Detection of Endotracheal Intubation

Michael Gottlieb et al. West J Emerg Med. 2018 Mar.

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Endotracheal intubation using the static technique to confirm placement. T, trachea; white arrow, endotracheal tube.
Figure 2
Figure 2
Esophageal intubation imaged with the static technique. T, trachea; E, esophagus; white arrow, endotracheal tube.
See this image and copyright information in PMC

References

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