Ultrasound imaging of saline-filled endotracheal tube cuff for accurate repositioning of tube during percutaneous dilatational tracheostomy

Shankar, K Anand; Nakra, Monish; Ramprasad, R.; Vikas, Srivastava

doi:10.1007/s00134-015-4189-z

Cited by 7 publications

(6 citation statements)

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“…Over time, we began to avoid repositioning the endotracheal tube through ultrasound guidance and favored direct visualization through laryngoscopy. A possible alternative to avoid this complication is to enhance ultrasound imaging by filling the endotracheal tube cuff with saline, as reported by Anand Shankar et al ( 22 ) The number of airway injuries was low (5.7%), and most of them were minor. The incidence of tracheoesophageal fistula was low (0.9%) and comparable to the literature, ( 13 ) although there are reports from the literature of such fistulas not occurring with the use of bronchoscopic guidance.…”

Section: Discussionmentioning

confidence: 99%

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

Bustamante,

Besen,

Botêga

et al. 2023

Crit Care Sci

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Objective To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials. Methods This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021. Results There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%. Conclusion Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.

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Section: Discussionmentioning

confidence: 99%

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

Bustamante,

Besen,

Botêga

et al. 2023

Crit Care Sci

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“…However, although this prevents tube-related complications, there is the risk of involuntary extubation [8,11]. Therefore, to be able to overcome tube-related complications, the procedure has been modified with some methods such as FOB [6], flexible lightwand [8], and inflation of the ETT cuff with saline [12]. Each of these methods has different limitations.…”

Section: Discussionmentioning

confidence: 99%

“…However, a worsening of ventilation leading to hypercarbia and/or hypoxia seen in approximately 16.7% of patients is the most significant disadvantage [13]. Shankar et al filled the ETT cuff with saline following the determination of the anatomic structures with USG and emphasized that damage of the tube cuff could be determined [12]. Nevertheless, the risk of aspiration that can emerge as a result of cuff rupture is the most significant disadvantage of this technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…Shankar et al filled the ETT cuff with saline following the determination of the anatomic structures with USG and emphasized that damage of the tube cuff could be determined [12]. Nevertheless, the risk of aspiration that can emerge as a result of cuff rupture is the most significant disadvantage of this technique [12].…”

Section: Discussionmentioning

confidence: 99%

“…In some studies, USG has been used alone. Despite the clear identification of anatomic and vascular structures with USG, no effect on ETT complications has been reported [12,14]. Finally, a recent study has recommended the use of lightwand, which is a simple, cost-effective method used in difficult airway management, to prevent tube-related complications in particular.…”

Section: Discussionmentioning

confidence: 99%

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The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure

Boran¹,

Bilal²,

Çakır³

et al. 2019

Cureus

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The aim of this study was to evaluate the effect of the flexible lightwand and ultrasonography (USG) combination on reducing the complications in percutaneous dilatational tracheostomy (PDT) opened with the forceps dilatation method. A retrospective examination was made of 138 patients between January 2014 and December 2018. Before starting to process, the anatomic structures of the patients were visualized with USG and the tracheostomy area was marked. Sedation and local anesthesia were applied to patients before the procedure, then the percutaneous tracheostomy was performed using the Griggs technique after confirmation of the tracheostomy localization defined with USG using the transillumination method with a flexible lightwand within an endotracheal tube. Complications that developed associated with the procedure were recorded. The mean age of the patients was 59.1±22.0 years and the mean length of stay in the intensive care unit was 42.3±35.5 days (range, 11-207 days). Overall, complications developed in 22 (15.6%) patients, of which 10.7% were early complications (1.4% related to the tube, 5.8% minor and 3.5% major complications). Tube- related complications were seen to develop in two patients. In the evaluation of the early minor complications, the most frequently seen complication was minor bleeding in 5.8% of the patients. No major vessel bleeding was determined in any patient in the early or late period. Of the late complications, the infection was seen to develop in four (2.8%) patients and stenosis in three (2.1%). The combination of flexible lightwand and USG in the PDT procedure minimized tube-related complications and contributed to the prevention of bleeding complications.

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Ultrasound in Airway Management

Zhang

Teoh²,

Kristensen

2020

Curr Anesthesiol Rep

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Ultrasound imaging of saline-filled endotracheal tube cuff for accurate repositioning of tube during percutaneous dilatational tracheostomy

Cited by 7 publications

References 0 publications

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

The Effect of Flexible Lightwand and Ultrasonography Combination on Complications of the Percutaneous Dilatational Tracheostomy Procedure

Ultrasound in Airway Management

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