Real-Time Ultrasound Guided the New Standard Technique for Percutaneous Dilatational Tracheostomy (PDT)

Copyright © 2015, Iranian Society of Regional Anesthesia and Pain Medicine (ISRAPM). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited. Several studies demonstrated that percutaneous dilatational tracheostomy (PDT) is a safe, easy, low-cost and minimally-invasive bedside method with numerous known advantages more than surgical tracheostomy such as fewer adjacent tissue injury, lesser bleeding risk, wound infectivity (morbidity) and mortality (1, 2). PDT technique is usually done with the help of fiberscope guide for more security and accurateness of the practice. Blind PDT technique has several disadvantages including failure to recognize accurate point of opening and position of tracheostomy pipe, chance of damage to nearby structures and false passageway. PDT with bronchoscopic guide can lessen these hesitations (3). However, it has its own difficulties such as disorder of ventilation particularly in patients with elevated of Positive End-Expiratory Pressure (PEEP) and considerable hypercarbia through risk of increased intracranial pressure. Therefore, patients with spinal cord or head damage may weakly tolerate this method (2, 3). Recently, portable ultrasonography is used in these cases for pre-intubation evaluation of upper airway, postintubation confirmation of endo-tracheal tube position, and extubation tracheal tube result (4). However, there is limited information and observational study data that supports the efficacy and safety of ultrasonography guided of PDT (5, 6). Ultrasonography has numerous advantages. It is individually portable, reliable, safe, pain-free, low-cost and simply available (7). Portable and real-time ultrasound has further advantage for facilitating the clinicians toward identifying the needle passageway by presentation dislocation of tissues in front of the needle (6, 8) (Figure 1). Sharp groove in anterior tracheal wall with incursion of needle and following flattening might be more visible by this procedure (5).