Real-time ultrasound-guided percutaneous dilatational tracheostomy 英文参考文献.docVIP

Rodríguez and Esteves Critical Care 2011, 15:443 /content/15/5/443 LETTER Real-time ultrasound-guided percutaneous dilatational tracheostomy Shalim J Rodríguez* and Luis E Esteves See related research by Rajajee et al., /content/15/1/R67 We read with interest the study conducted by Dr Rajajee and colleagues [1] and we do support the potential of ultrasound in the critical care setting [2]. We have observed that the best way to visualize arti? cial airways is with a longitudinal image of the trachea (Figure 1). Transversal images allow one to visualize the tube, but do not give certainty about its position when removed. In a longitudinal image, one can visualize a double line for the whole extension of the tube, enabling recognition of the distal tip [3]. When removing the tube, we visualize the process because of the unique line with increased echogenicity of the posterior surface of the trachea, which is well recognized if the space between the tracheal rings is free. Removal of the endotracheal tube might be insu? cient using the laryngoscope, particularly in patients with short necks. Once the guidewire is in place, it can be visualized and followed with ultrasound (Figur e guidewire is shown in the transversal Figure 1. Removal of the orotracheal tube visualized in a longitudinal image. The tube is recognized as a double line (white arrow), leaving a single line that corresponds to the trachea. Author’s image. image and in the longitudinal image, as it passes among the tracheal rings. e guidewire is observed in the airway by following it with ultrasound of the skin. Ultrasound techniques should be used routinely to evaluate anterior structures of the neck, regardless of the guide use e ability to visualize the path of the needle 2. 3. 4. Adrienne R, Cook D: Ultrasound guidance for placement of central venous catheters: a meta analysis of the literature.