PURPOSE: To assess the utility of tracheal ultrasound as a screening tool prior to percutaneous dilatational tracheostomy (PDT).
METHODS: Forty four (44) mechanically ventilated patients in a surgical intensive care unit underwent ultrasound screening of the trachea prior to planned PDT using a Sonosite M-Turbo machine. Screening included anatomical analysis of the trachea and the surrounding structures including identification of the cricoid cartilage, second tracheal ring, thyroid isthmus and any vascular anomalies.
RESULTS: Ultrasound analysis identified 12 patients (27%) with significant anatomic variations which prompted cancellation of a percutaneous tracheostomy and conversion to a planned open surgical tracheostomy. These included 5 patients with a high riding innominate artery, 5 with inferiorly displaced cricoid cartilages with the second tracheal ring below the sternal notch, and 2 large thyroid goiters. These findings were not appreciated by surface landmarks. There were 32 patients that subsequently underwent an uncomplicated PDT.
CONCLUSIONS: Ultrasound identified anatomic variations in a significant number of patients not appreciated on physical examination alone.
CLINICAL IMPLICATIONS: Ultrasound screening prior to percutaneous tracheostomy may help to avoid serious complications such as cranial misplaced trachea, bleeding, and tracheoinnominate fistula and provides additional information that may improve the safety of the procedure.
DISCLOSURE: The following authors have nothing to disclose: Adel Bassily-Marcus, Kaare Weber, Leon Boudourakis, Satyanarayana Reddy Mukkera, John Oropello, Anthony Manasia, Roopa Kohli-Seth, Ernest Benjamin
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