Ultrasound-guided percutaneous dilatational tracheostomy with laryngeal mask airway control in a morbidly obese patient

Šustić, Alan; Župan, Željko; Antončić, Igor

doi:10.1016/j.jclinane.2003.04.005

Cited by 60 publications

(17 citation statements)

References 12 publications

(25 reference statements)

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“…Several studies have emphasized the value of pre-PCT US examination of the neck region to reduce the incidence of complications [14-16,20-25]. Recently, Rajajee and colleagues [18] demonstrated the feasibility of US guidance during the implementation of PCT in a population of neuro-intensive care patients.…”

Section: Discussionmentioning

confidence: 99%

“…This is notably the case for improving procedures (central venous cannulation, arterial cannulation, and peripheral nerve block) in obese patients [13]. With respect to PCT, several studies have demonstrated the value of US mapping of the neck region prior to PCT [14-16]. Indeed, US examination often modifies the puncture site with respect to that chosen solely on the basis of anatomical palpation data [17].…”

Section: Introductionmentioning

confidence: 99%

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Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

et al. 2012

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IntroductionThe purpose of this study was to evaluate the feasibility of ultrasound (US)-guided percutaneous tracheostomy (PCT) and the incidence of complications in critically ill, obese patients.MethodsFifty consecutive patients were included in a prospective study in two surgical and critical care medicine departments. Obesity was defined as a body mass index (BMI) of at least 30 kg/m2. The feasibility of PCT and the incidence of complications were compared in obese patients (n = 26) and non-obese patients (n = 24). Results are expressed as the median (25th-75th percentile) or number (percentage).ResultsThe median BMIs were 34 kg/m2 (32-38) in the obese patient group and 25 kg/m2 (24-28) in the non-obese group (p < 0.001). The median times for tracheostomy were 10 min (8-14) in non-obese patients and 9 min (5-10) in obese-patients (p = 0.1). The overall complication rate was similar in obese and non-obese patient groups (35% vs. 33%, p = 0.92). Most complications were minor (hypotension, desaturation, tracheal cuff puncture and minor bleeding), with no differences between obese and non-obese groups. Bronchoscopic inspection revealed two cases of granuloma (8%) in obese patients. One non-obese patient developed a peristomal skin infection, which was treated with intravenous antibiotics. Ultrasound-guided PCT was possible in all enrolled patients and there were no surgical conversions or deaths.ConclusionsThis study demonstrated that US-guided PCT is feasible in obese patients with a low complication rate. Obesity may not constitute a contra-indication for US-guided PCT. A US examination provides information on cervical anatomy and hence modifies and guides choice of the PCT puncture site.Trial registrationClinicalTrials.gov: NCT01502657.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

et al. 2012

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“…One study described using Doppler ultrasound over the trachea to determine the correct position of the orotracheal tube [30], a technique which is, in our anecdotal experience, less reliable than direct laryngoscopy or bronchoscopy. Laryngeal mask airways have been used successfully instead of orotracheal tubes during PT [31,32], although the relative safety of this technique is debatable [33]. In view of the other advantages, detailed above, it is possible that real-time ultrasound guidance of the needle path will find a role as a routine adjunct, rather than alternative, to standard bronchoscopy-guided PT.…”

Section: Discussionmentioning

confidence: 99%

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

et al. 2011

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IntroductionUltrasound (US) performed prior to percutaneous tracheostomy (PT) may be useful in avoiding injury to pretracheal vascular structures and in avoiding high placement of the tube. Bedside real-time US guidance with visualization of needle path is routinely utilized for other procedures such as central venous catheterization, and may enhance the safety and accuracy of PT without causing airway occlusion or hypercarbia. Our objective was to demonstrate that PT performed under real-time US guidance with visualization of needle path during tracheal puncture is feasible, including in patients with features that increase the technical difficulty of PT.MethodsMechanically ventilated patients with acute brain injury requiring tracheostomy underwent US guided PT. The orotracheal tube was withdrawn using direct laryngoscopy. The trachea was punctured under real-time US guidance (with visualization of the needle path) while using the acoustic shadows of the cricoid and the tracheal rings to identify the level of puncture. After guidewire passage the site and level of entry was verified using the bronchoscope, which was then withdrawn. Following dilatation and tube placement, placement in the airway was confirmed using auscultation and the "lung sliding" sign on US. Bronchoscopy and chest X-ray were then performed to identify any complications.ResultsThirteen patients successfully underwent US guided PT. Three patients were morbidly obese, two were in cervical spine precautions and one had a previous tracheostomy. In all 13 patients bronchoscopy confirmed that guidewire entry was through the anterior wall and between the first and fifth tracheal rings. There was no case of tube misplacement, pneumothorax, posterior wall injury, significant bleeding or other complication during the procedure.ConclusionsPercutaneous tracheostomy performed under real-time ultrasound guidance is feasible and appears accurate and safe, including in patients with morbid obesity and cervical spine precautions. Larger studies are required to further define the safety and relative benefits of this technique.Trial registrationUMIN Clinical Trials Registry, UMIN000005023.

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“…US-guided PDT results in a significantly lower rate of cranial misplacement of the tracheostomy tube than “blind” placement [84]. The distance from the skin surface to the tracheal lumen can be measured in order to predetermine the length of the puncture cannula that is needed to reach the tracheal lumen without perforating the posterior wall [85]. The distance can also be used to determine the optimal length of the tracheostomy cannula [86].…”

Section: Resultsmentioning

confidence: 99%

“…The distance can also be used to determine the optimal length of the tracheostomy cannula [86]. Successful US-guided PDT has been utilised when bronchoscope-guided techniques were abandoned [85]. Bronchoscope guided PDT also often results in considerable hypercapnia, whereas ultrasound Doppler-guided PDT does not [87].…”

Section: Resultsmentioning

confidence: 99%

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

et al. 2014

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ObjectivesTo create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians.MethodsThis is a narrative review combined with a structured Medline literature search.ResultsUltrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size.ConclusionsUltrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits.Teaching Points• Ultrasonography is becoming essential in management of the upper and lower airways.• The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation.• Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax.• Point-of-care ultrasonography of the airways has a steep learning curve.• Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.

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Ultrasound-guided percutaneous dilatational tracheostomy with laryngeal mask airway control in a morbidly obese patient

Cited by 60 publications

References 12 publications

Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

Ultrasound-guided percutaneous tracheostomy in critically ill obese patients

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study

Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae

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