The ultrasound neck imaging for tracheostomy study: A study prompting ultrasound screening prior to percutaneous tracheostomy procedures to improve patient outcomes

Rees, James; Haroon, Yumna; Hogan, Chris; Saha, Shibaji; Derekshani, Sharam

doi:10.1177/1751143717739570

Cited by 15 publications

(9 citation statements)

References 16 publications

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“…Injury to blood vessels was highlighted in previous studies and they recommended the use of ultrasound to identify them, 16,17 and interestingly, a research in London collecting data from computerized tomography (CT) angiography to study neck vasculature; revealed that 187 out of 343 patients (55%) verified a pre-tracheal vessel; vein in 131 and artery in 56. 18 Three previous randomized controlled trials [19][20][21] compared USPDT with landmark or bronchoscopy guided PDT; the total minor complication rates vary between 11.52% to 56.75 %; without difference between both compared groups. Contrarily, the current results showed a lower total minor complication rate in the bronchoscopy group (P<0.05).…”

Section: Discussionmentioning

confidence: 99%

Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

Ahmed

Abdalla

Abotaleb

2020

Al-Azhar International Medical Journal

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Background: Percutaneous dilatational tracheostomy (PDT) is an inevitable procedure indicated for mechanically ventilated critically ill patients. Ultrasound (US) assisted PDT has emerged increasing safety issues. Case series were reported to confirm the advantages of USPDT. Aim: The present study aimed to compare patients subjected to USPDT with those subjected to bronchoscope guided PDT only, regarding the easiness of technique, efficacy and safety. Materials and Methods: A prospective, randomized, comparative clinical study carried on 49 adults mechanically ventilated critically ill patients in need to maintain a secure airway through elective PDT, using Ciaglia's Blue Rhino percutaneous dilatational tracheostomy technique. 5 patients were excluded for surgical conversion, and the remaining 44 were randomly divided into 2 groups; PDT group: patients subjected to fiber optic guided PDT, and USPDT group: patients underwent pre-procedural US imaging followed by fiber optic guided PDT. Time of the technique, procedure failure, procedure difficulty, and complications were documented, our follow up ends 24-hours after the technique. Results: Pre-procedural US guided PDT was found to be easier (P<0.05), 1 puncture was needed in the USPDT group (P<0.05) with shorter time (P<0.001). The puncture site was changed in 31.8% of the PDT group of patients but not in the USPDT group. The pre-procedural US group showed less bleeding, transient hypoxemia (P<0.05) and total number of patients with minor complications (P<0.05). Conclusion: Pre-procedural ultrasound assessment of trachea and Para-tracheal soft tissues can be considered as a reliable tool to increase safety and improve outcomes of percutaneous tracheostomy.

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Section: Discussionmentioning

confidence: 99%

Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

Ahmed

Abdalla

Abotaleb

2020

Al-Azhar International Medical Journal

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“…A small study evaluated the use of US prior to PDT in 72 patients, and the planned puncture site was changed in 17 patients (24%) to avoid injury to subcutaneous vessels (25). Forty-one percent of patients in one study were found to have a vessel, most commonly veins, overlying the planned percutaneous tracheostomy insertion site on neck US (33).…”

Section: Pre-procedures Usementioning

confidence: 99%

State of the art: percutaneous tracheostomy in the intensive care unit

Ghattas¹,

Alsunaid²,

Pickering³

et al. 2021

J Thorac Dis

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Percutaneous tracheostomy is a commonly performed procedure for patients in the intensive care unit (ICU) and offers many benefits, including decreasing ICU length of stay and need for sedation while improving patient comfort, effective communication, and airway clearance. However, there is no consensus on the optimal timing of tracheostomy in ICU patients. Ultrasound (US) and bronchoscopy are useful adjunct tools to optimize procedural performance. US can be used pre-procedurally to identify vascular structures and to select the optimal puncture site, intra-procedurally to assist with accurate placement of the introducer needle, and post-procedurally to evaluate for a pneumothorax. Bronchoscopy provides real-time visual guidance from within the tracheal lumen and can reduce complications, such as paratracheal puncture and injury to the posterior tracheal wall. A step-by-step detailed procedural guide, including preparation and procedural technique, is provided with a team-based approach. Technical aspects, such as recommended equipment and selection of appropriate tracheostomy tube type and size, are discussed. Certain procedural considerations to minimize the risk of complications should be given in circumstances of patient obesity, coagulopathy, or neurologic illness. Herein, we provide a practical state of the art review of percutaneous tracheostomy in ICU patients. Specifically, we will address pre-procedural preparation, procedural technique, and post-tracheostomy management.

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“…Easily identifiable structures include tracheal midline, thyroid isthmus, anterior jugular vein (51), tracheal rings, and pre-tracheal vessels overlying the PDT site (52). Use of color doppler, presence of vascular pulsatility or compressibility allow for easy discrimination between veins and arteries.…”

Section: Use Of Ultrasoundmentioning

confidence: 99%

Patient selection and preoperative evaluation of percutaneous dilation tracheostomy in the intensive care unit

Barash¹,

Kurman²

2021

J Thorac Dis

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Percutaneous dilation tracheostomy (PDT) is increasingly performed at the bedside of critically ill patients in the intensive care unit (ICU). PDT is safe overall and has a number of benefits compared to surgical tracheostomy. A tracheostomy tube has numerous advantages compared to an endotracheal tube, including decreased work of breathing, ease of connecting to a mechanical ventilator, improved patient comfort and pulmonary hygiene. Common patient populations include those unable to wean from mechanical ventilation, those requiring enhanced pulmonary hygiene, and those with progressive neuromuscular weakness. Clinicians performing this procedure should be familiar with common indications for performing tracheostomy as well as absolute and relative contraindications. Special patient populations, including those with morbid obesity, aberrant anatomic and vascular anatomy, cervical spine injury, and high ventilatory requirements, should be approached with careful planning. Pre-procedure evaluation for coagulopathy, including basic laboratory analysis and medication review, should be undertaken. Preprocedure ultrasound may be used to more accurately identify landmarks and vascular structures. The optimal timing for performing PDT is unknown and depends on the unique characteristics of each patient, perceived natural history of the disease process being addressed and open conversations with the patient or surrogate decision maker. In this review, we identify patient populations most likely to benefit from PDT and outline data behind optimal timing, pre-procedural laboratory evaluation and patient specific factors that may influence procedural success.

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The ultrasound neck imaging for tracheostomy study: A study prompting ultrasound screening prior to percutaneous tracheostomy procedures to improve patient outcomes

Cited by 15 publications

References 16 publications

Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

State of the art: percutaneous tracheostomy in the intensive care unit

Patient selection and preoperative evaluation of percutaneous dilation tracheostomy in the intensive care unit

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