Ultrasound-guided percutaneous tracheostomy

Overview

Percutaneous tracheostomy (PT) is a common bedside procedure in the intensive care unit (ICU). Successful outcome requires midline needle puncture between the second and fourth tracheal rings and avoidance of posterior wall and vascular trauma.

Kearney et al reported rates of perioperative morbidity of 6% and procedure-related mortality of 0.6%. Placement complications include hemorrhage, accidental extubation, pneumothorax, formation of a false passage, damage to tracheal rings, and perforation of the posterior tracheal wall. Delayed bleeding is typically seen a few days after PT and is due to either minor vessel damage or erosion into high or aberrant mediastinal vessels. The latter can be life-threatening and necessitates immediate surgical input. The most important late complications are tracheal stenosis, tracheomalacia, and vocal cord dysfunction, which could adversely affect the quality of life of ICU survivors. ^,

Point-of-care ultrasound (US) is increasingly being used for the management of critically ill patients. Despite wide application, US-guided percutaneous tracheostomy (USGPT) is not yet routine practice in many centers. Preprocedural, real-time US can reduce some of the complications just mentioned, morbidity, and possibly the occasional mortality associated with PT. This chapter focuses on the role of US for PT, the sonographic anatomy of the anterior neck region, and the evidence available for USGPT.