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

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Real-time ultrasound-guided percutaneous dilatational tracheostomy a feasibility study 英文参考文献.doc

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Real-time ultrasound-guided percutaneous dilatational tracheostomy a feasibility study 英文参考文献

Real-timeultrasound-guidedpercutaneous dilatationaltracheostomy:afeasibilitystudy Rajajeeetal. Rajajeeetal.CriticalCare2011,15:R67 /content/15/1/R67(22February2011) Rajajeeetal.CriticalCare2011,15:R67 /content/15/1/R67 RESEARCH OpenAccess Real-timeultrasound-guidedpercutaneous dilatationaltracheostomy:afeasibilitystudy VenkatakrishnaRajajee1*,JeffreyJFletcher1,LaurynRRochlen2,TeresaLJacobs1 Abstract Introduction:Ultrasound(US)performedpriortopercutaneoustracheostomy(PT)maybeusefulinavoidinginjury topretrachealvascularstructuresandinavoidinghighplacementofthetube.Bedsidereal-timeUSguidancewith visualizationofneedlepathisroutinelyutilizedforotherproceduressuchascentralvenouscatheterization,and mayenhancethesafetyandaccuracyofPTwithoutcausingairwayocclusionorhypercarbia.Ourobjectivewasto demonstratethatPTperformedunderreal-timeUSguidancewithvisualizationofneedlepathduringtracheal punctureisfeasible,includinginpatientswithfeaturesthatincreasethetechnicaldifficultyofPT. Methods:MechanicallyventilatedpatientswithacutebraininjuryrequiringtracheostomyunderwentUSguided PT.Theorotrachealtubewaswithdrawnusingdirectlaryngoscopy.Thetracheawaspuncturedunderreal-timeUS guidance(withvisualizationoftheneedlepath)whileusingtheacousticshadowsofthecricoidandthetracheal ringstoidentifythelevelofpuncture.Afterguidewirepassagethesiteandlevelofentrywasverifiedusingthe bronchoscope,whichwasthenwithdrawn.Followingdilatationandtubeplacement,placementintheairwaywas confirmedusingauscultationandthe“lungsliding”signonUS.BronchoscopyandchestX-raywerethen performedtoidentifyanycomplications. Results:ThirteenpatientssuccessfullyunderwentUSguidedPT.Threepatientsweremorbidlyobese,twowerein cervicalspineprecautionsandonehadaprevioustracheostomy.Inall13patientsbronchoscopyconfirmedthat guidewireentrywasthroughtheanteriorwallandbetweenthefirstandfifthtrachealrings.Therewasnocaseof tubemisplacement,pneumothorax,posteriorwallinjury,significantbleedingorothercomplicationduringthe procedure. Conclusion