Real-time ultrasound-guided percutaneous dilatational tracheostomy

Chacko, Jose; Jahan, Nikahat; Brar, Gagan; Kumar, Umesh; Moorthy, Ramanathan

doi:10.1007/s00134-012-2514-3

Cited by 58 publications

(33 citation statements)

References 8 publications

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“…Ultrasonography allows real-time [81, 82] localisation of the trachea, visualisation of the anterior tracheal wall and pretracheal tissue including blood vessels [83], and selection of the optimal intercartilaginous space for placement of the tracheostomy tube [84]. US-guided PDT results in a significantly lower rate of cranial misplacement of the tracheostomy tube than “blind” placement [84].…”

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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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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“…19,20 No literature existed to answer any of the two question we made. Likewise, a recent systematic review failed to identify such a trial.…”

Section: Rationalementioning

confidence: 99%

A proposed novel ultrasound-guided percutaneous dilatational tracheostomy technique - the in-plane wire-in-needle approach: study design and rationale for multicenteric randomized controlled clinical trial

Al-Ansari

Aljamaan

2016

Int J Clin Trials

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INTRODUCTIONAs Ultra Sound (US) technology continues to progress, its scope becomes only limited by the operator expertise, not the bedside US unit. With the increasing availability of bedside ultrasonography in the intensive care setting, real-time ultrasound guidance have been advocated as potential tools to further improve the safety and efficacy of the US-PDT procedure.1,2 Two-dimensional (2D) ultrasound imaging is the most commonly used guidance for needle placement during US-PDT due to its real-time nature and low cost. Needle visualization is important for ABSTRACT Background: The current evidence regarding the applications of Ultra Sound (US) in Percutaneous Dilatational Tracheostomy (PDT) is encouraging. US guided PDT (US-PDT) has recently been recommended in difficult cases and is given a preference compared to bronchoscope guided PDT. The question on the difference in safety and efficacy of the different approaches in US-PDT (with or without the use of any technique to improve needle visualization) during US-PDT and whether it is likely to make a difference needs to be answered. Methods: Literatures examining the different US-PDT approaches as well as whether any technique to improving needle visualization that has been used during US-PDT in MEDLINE, PubMed, EMBAS E, and the Cochrane Central Register of Controlled Trials were searched for in an attempt to answer the two questions raised. No study has yet compared the in plane to the out of plane approach for US-PDT nor looked at improving needle visualization during US-PDT. This raised the need for a clinical trial looking at the difference between the different US-PDT approaches with or without ways to improve needle visualization during US-PDT. Results: Utilizing the best available evidence in US guided procedures in the Intensive Care Units (ICU), we proposed a study design that we think is likely to make a difference in US-PDT practice. The study is designed to assess the safety and efficacy of US guided PDT using the in-plane (I.P.) approach enhanced with the use of Wire-inneedle approach (W.I.N.A) and rocking motion of the transducer compared to the traditional out-of-plane approach without W.I.N.A. Conclusions:The proposed (In-plane Wire-In-needle approach = I.P.W.I.N.A) as a potential to be a standard of care in US-PDT has its own limitations. Its safety, efficacy and feasibility in Randomized Controlled Clinical Trials research settings needs to be tested and verified.

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“…[33] The introducer needle and guidewire may be precisely inserted at the appropriate interspace on the trachea, in the midline, using real-time ultrasound guidance and possibly obviate the need for routine bronchoscope use. [34]…”

Section: Ultrasonography Of the Airwaymentioning

confidence: 99%

Bedside ultrasonography-Applications in critical care: Part II

Chacko

Brar

2014

Indian Journal of Critical Care Medicine

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Point of care ultrasonography, performed by acute care physicians, has developed into an invaluable bedside tool providing important clinical information with a major impact on patient care. In Part II of this narrative review, we describe ultrasound guided central venous cannulation, which has become standard of care with internal jugular vein cannulation. Besides improving success rates, real-time guidance also significantly reduces the incidence of complications. We also discuss compression ultrasonography - a quick and effective bedside screening tool for deep vein thrombosis of the lower extremity. Abdominal ultrasound offers vital clues in the emergency setting; in the unstable trauma victim, a focused examination may provide immediate answers and has largely superseded diagnostic peritoneal lavage in diagnosing intraperitoneal bleed. From estimation of intracranial pressure to transcranial Doppler studies, ultrasound is becoming increasingly relevant to neurocritical care. Ultrasound may also help with airway management in several situations, including percutaneous tracheostomy. Clearly, bedside ultrasonography has become an indispensable part of intensive care practice – in the rapid assessment of critically ill-patients as well as in enhancing the safety of invasive procedures.

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Real-time ultrasound-guided percutaneous dilatational tracheostomy

Cited by 58 publications

References 8 publications

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

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

A proposed novel ultrasound-guided percutaneous dilatational tracheostomy technique - the in-plane wire-in-needle approach: study design and rationale for multicenteric randomized controlled clinical trial

Bedside ultrasonography-Applications in critical care: Part II

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