Use of ultrasound guidance to improve the safety of percutaneous dilatational tracheostomy: a literature review

Abstract

Patients in ICUs frequently require tracheostomy for long-term ventilator support, and the percutaneous dilatational tracheostomy (PDT) method is preferred over surgical tracheostomy. The use of ultrasound (US) imaging to guide ICU procedures and interventions has recently emerged as a simple and noninvasive tool. The current evidence regarding the applications of US in PDT is encouraging; however, the exact role of US-guided dilatational tracheostomy (US-PDT) remains poorly defined. In this review, we describe the best available evidence concerning the safety and efficacy of US-PDT and briefly delineate the general principles of US image generation for the airway and of US-PDT procedures.

Fig. 1

Sonogram of the hyoid bone (H) on a midline transverse view using a linear transducer. The hyoid bone is shown as an inverted, hyper-echoic U. PAS, posterior acoustic shadow; SM, strap muscles. Reprinted with permission from Wolters Kluwer [42]

Fig. 2

Transverse view at the thyroid cartilage using a linear transducer. Note the difference in echogenicity between the true cords because of the presence of the vocalis muscle (A) (TC, Thyroid cartilage; SM, Strap muscles; AC, Arytenoid cartilage; V, Vocalis muscle; VL, Vocal ligaments;) and the increased fat content in the false cords (B) (TC, Thyroid cartilage; SM, Strap muscles; FC, False cord;). Reprinted with permission from Wolters Kluwer [42]

Fig. 3

Transverse view at the cricoid cartilage. A-M, air mucosal interface; CC, cricoid cartilage; CTA, comet tail artefacts; SM, strap muscles. Reprinted with permission from Wolters Kluwer [42]

Fig. 4

Left parasagittal view at the trachea. A-M, air-mucosal interface; CC, cricoid cartilage; CTA, comet tail artefact; T1-T3, tracheal cartilage. Reprinted with permission from Wolters Kluwer [42]

Fig. 5

Transverse view at the level of the suprasternal notch (SSN) showing the trachea and the thyroid gland. A-M, air-mucosal interface; CTA, comet tail artefact; Is, isthmus; TG, thyroid gland; Trc, tracheal cartilage (ring). Reprinted with permission from Wolters Kluwer [42]