real-time ultrasound-guided percutaneous dilatational tracheostomy a feasibility study实时超声引导下经皮膨胀气管造口术可行性研究.pdfVIP

Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study Rajajee et al. Rajajee et al. Critical Care 2011, 15:R67 /content/15/1/R67 (22 February 2011) Rajajee et al. Critical Care 2011, 15:R67 /content/15/1/R67 RESEARCH Open Access Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study 1* 1 2 1 Venkatakrishna Rajajee , Jeffrey J Fletcher , Lauryn R Rochlen , Teresa L Jacobs Abstract Introduction: Ultrasound (US) performed prior to percutaneous tracheostomy (PT) may be useful in avoiding injury to pretracheal vascular structures and in avoiding high placement of the tube. Bedside real-time US guidance with visualization of needle path is routinely utilized for other procedures such as central venous catheterization, and may enhance the safety and accuracy of PT without causing airway occlusion or hypercarbia. Our objective was to demonstrate that PT performed under real-time US guidance with visualization of needle path during tracheal puncture is feasible, including in patients with features that increase the technical difficulty of PT. Methods: Mechanically ventilated patients with acute brain injury requiring tracheostomy underwent US guided PT. The orotracheal tube was withdrawn using direct laryngoscopy. The trachea was punctured under real-time US guidance (with visualization of the needle path) while using the acoustic shadows of the cricoid and the tracheal rings to identify the level of puncture. After guidewire passage the site and level of entry was verified using the bronchoscope, which