RSNA 2005 

Abstract Archives of the RSNA, 2005


LPD13-03

Advantages of Ultrasound in Percutaneous Dilatational Tracheostomy

Scientific Posters

Presented on November 28, 2005
Presented as part of LPD13: Ultrasound (Head and Neck)

Participants

Alpaslan Yavuz MD, Presenter: Nothing to Disclose
Kagan Ceken MD, Abstract Co-Author: Nothing to Disclose
Murat Yilmaz MD, Abstract Co-Author: Nothing to Disclose
Emel Alimoglu MD, Abstract Co-Author: Nothing to Disclose
Adnan Kabaalioglu MD, Abstract Co-Author: Nothing to Disclose
Ali Apaydin MD, Abstract Co-Author: Nothing to Disclose

PURPOSE

Recently percutaneous dilatational tracheostomy(PDT) has become an important interventional procedure which is performed in prolonged ventilated patients in Intensive Care Units (ICU). The purpose of this study is to evaluate the utility of pre-incisional ultrasound (US) control of the neck to avoid complications and to reveal the advantages of performing PTD under sonography guidiance.

METHOD AND MATERIALS

In 6 months period, 96 ICU patients underwent PDT were included and we devided the patients into two groups at random. In group A (n=44, mean age 56 years) US control of the puncture area and the adjacent anatomical structures was made. Possible causes of complications such as short neck, altered tracheal anatomy, subcutaneous vascularity, thyroid nodules, endotracheal tube’s cuff level, highly localized innominate artery were determined. With US imaging, endotracheal tube’s cuff drawn back to a safe level to avoid perforation and seeking needle's insertion point was checked according to the midline and tracheal rings. If misplacement was detected, the puncture level was changed. In group B (n=52, mean age 59 years), the procedure was completed without US examination. Physical landmarks used to locate the insertion level.

RESULTS

In group A, first insertion level was corrected in 16 patients according to the US control. In five cases US aided puncture was prefered initially by clinician be cause of suboptimal conditions (short neck, massive goitre etc). The acute complications were; minimal hemorage in 3 patients and cuff perforation of endotracheal tube in 1 patient. In group B, acute complications were; major bleeding in 2 patiens (compressed wound-dressing and cotherization were used to control bleeding), minimal hemorage in 5 patients and cuff perforation of endotracheal tube in 5 patient.

CONCLUSION

Bedside PDT can be safer and more effective method by the use of ultrasound pre- and peroperatively. In this study, there is no significance statistical diffarance between the complication results but it’s suggested to enlarge the series. Acute complications of PDT can be reduced with US guidiance especially when the physical landmarks are insufficient to carry out the technique.

PURPOSE

Recently percutaneous dilatational tracheostomy(PDT) has become an important interventional procedure which is performed in prolonged ventilated patients in Intensive Care Units (ICU). The purpose of this study is to evaluate the utility of pre-incisional ultrasound (US) control of the neck to avoid complications and to reveal the advantages of performing PTD under sonography guidiance.

METHOD AND MATERIALS

In 6 months period, 96 ICU patients underwent PDT were included and we devided the patients into two groups at random. In group A (n=44, mean age 56 years) US control of the puncture area and the adjacent anatomical structures was made. Possible causes of complications such as short neck, altered tracheal anatomy, subcutaneous vascularity, thyroid nodules, endotracheal tube’s cuff level, highly localized innominate artery were determined. With US imaging, endotracheal tube’s cuff drawn back to a safe level to avoid perforation and seeking needle's insertion point was checked according to the midline and tracheal rings. If misplacement was detected, the puncture level was changed. In group B (n=52, mean age 59 years), the procedure was completed without US examination. Physical landmarks used to locate the insertion level.

RESULTS

In group A, first insertion level was corrected in 16 patients according to the US control. In five cases US aided puncture was prefered initially by clinician be cause of suboptimal conditions (short neck, massive goitre etc). The acute complications were; minimal hemorage in 3 patients and cuff perforation of endotracheal tube in 1 patient. In group B, acute complications were; major bleeding in 2 patiens (compressed wound-dressing and cotherization were used to control bleeding), minimal hemorage in 5 patients and cuff perforation of endotracheal tube in 5 patient.

CONCLUSION

Bedside PDT can be safer and more effective method by the use of ultrasound pre- and peroperatively. In this study, there is no significance statistical diffarance between the complication results but it’s suggested to enlarge the series. Acute complications of PDT can be reduced with US guidiance especially when the physical landmarks are insufficient to carry out the technique.

Cite This Abstract

Yavuz, A, Ceken, K, Yilmaz, M, Alimoglu, E, Kabaalioglu, A, Apaydin, A, Advantages of Ultrasound in Percutaneous Dilatational Tracheostomy.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4407349.html