Real-Time Ultrasound Guided the New Standard Technique for Percutaneous Dilatational Tracheostomy (PDT)

Ultrasound‐Guided Percutaneous Dilatational Tracheostomies in 2 Difficult Airways

“…A percutaneous dilatational tracheostomy is a better option than a surgical tracheostomy in patients with large midline neck tumors. Surgical techniques for tracheostomy have been associated with early tracheostomy dislodgement, infection, pneumothorax or pneumomediastinum, and fistulae, which could be avoided with a US‐guided percutaneous dilatational tracheostomy . The use of US to guide a percutaneous dilatational tracheostomy substantially reduces procedural complications .…”

Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway

“…6,16 These characteristics affirm its role as a valuable adjunct in airway assessment, particularly in the setting of cricothyroidotomy and PT, with roles in the pre-, intra-and post-procedural period. 5,14,17 This modality may provide important information less evident on clinical examination, especially in challenging cases (obesity, unfavourable anatomy/obscured landmarks, cervical spine precautions). 13,14 These factors most likely prompted the recent recommendation of ultrasound in both the Australian/New Zealand and Danish intensive care practice guidelines as a means of improving the safety of the technique.…”

“…Following the procedure, the ultrasound can help confirm the position and is a faster and more sensitive screening test for pneumothorax than chest radiography. 6,16,17,23 As air conducts ultrasound poorly, it limits visualisation of structures behind the air-membrane interface, such as the posterior tracheal wall. Ultrasound alone cannot exclude the possibility of injury, but assessing the distance to trachea and realtime visualisation of the needle path can give a guide as to a safe depth of needle advancement.…”

“…Ultrasound has been shown to be useful in delineating pre-and paratracheal airway anatomy, especially in cases where distortion or obesity obscured normal palpation, with improved speed and success of cannula placement and reduced number of attempts required. [15][16][17]23 Measuring the pretracheal soft-tissue distance can also help determine appropriate tracheostomy length (regular vs. extended). 16,17,22 Additionally, intra-procedural ultrasound may assist in identifying the correct level of puncture between the appropriate tracheal rings, guide midline placement of the needle and assist physicians to avoid vulnerable structures, particularly the thyroid isthmus and aberrant vessels, helping minimise the likelihood of immediate vascular complications.…”

“…[15][16][17]23 Measuring the pretracheal soft-tissue distance can also help determine appropriate tracheostomy length (regular vs. extended). 16,17,22 Additionally, intra-procedural ultrasound may assist in identifying the correct level of puncture between the appropriate tracheal rings, guide midline placement of the needle and assist physicians to avoid vulnerable structures, particularly the thyroid isthmus and aberrant vessels, helping minimise the likelihood of immediate vascular complications. Following the procedure, the ultrasound can help confirm the position and is a faster and more sensitive screening test for pneumothorax than chest radiography.…”