The following is a summary of “Comparison of dynamic versus static ultrasound to confirm endotracheal tube depth,” published in the December 2023 issue of Emergency Medicine by Gottlieb, et al.

Once the endotracheal tube (ETT) is in place, the site of the ETT is checked, and then the ETT depth is measured. A physical check is only sometimes accurate, and lung X-rays can cause problems with early diagnosis. Ultrasound may make it easier to quickly find the ETT depth at the bedside, but people need to learn the best method.

A body model was used in this randomized study to compare the static and dynamic methods for ETT depth measurement. The ETT was given either right or deep placement at random. A group of seven doctors who were not told where the ETT was placed evaluated the site using both static (direct visualization of a swollen cuff) and dynamic (active visualization of the ETT cuff expanding) visualization. Results showed how accurate the diagnosis was, how long it took to identify the problem, and how confident the operator was. There were also split studies based on the ultrasound experience of the doctors.

A total of 420 tests were done. There was a 99.1% (95% CI) chance that the static method was sensitive and a 97.1% (95% CI) chance that it was specific. The dynamic method was 100% sensitive (95% CI 96.7%–100%) and 100% specific (95% CI 96.7%–100%). The static method took less time to identify (6.6 s vs. 8.7 s; 95% CI 5.9–7.4 s) than the dynamic method (8.7 s vs. 8.0–9.5 s). The operator had less faith in the static technique (4.4 out of 5.0; 95% CI 4.3 to 4.5) than the dynamic technique (4.7 out of 5.0; 95% CI 4.6 to 4.8). The results were the same whether they were looked at by expert or non-expert sonographers. The steady or dynamic method did not statistically significantly affect how well ETT depth recognition worked. However, using the dynamic method led to a statistically significant rise in sonographer trust and an increase in the time it took to identify the object.

Source: sciencedirect.com/science/article/abs/pii/S0735675723004850