|
|
|
|
|
| Clinical controlled study of location by traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy |
| Wu Qiao-yun, Ding Wei-qiang, Li tao, Yang Hong-ying, Zhang Wen-jun, Wang Yun-hui, Liu Li-xia |
| Critical Care Medicine, the General Hospital of Fengfeng Group, Handan 056200, China |
|
|
|
|
Abstract Objective To evaluate the procedural safety and efficacy of ultrasound guidance during percutaneous dilatational tracheostomy (PDT). Methods Between January 2015 and December 2016, 50 consecutive patients were included in the study, the patients were divided randomly into two groups. In group USPDT (n=25), PDT was performed by using ultrasound guidance. In group ALPDT (n=25), PDT was performed by using traditional anatomical landmarks. The parameters of vital signs, age, gender, height, weight, the Acute Physiology and Chronic Health Evaluation Ⅱ score (APACHEⅡ), the Sequential Organ Failure Assessment (SOFA) were recorded at the time of enrollment. The procedure time, first-pass success rate, number of puncture, amount of bleeding and complications were recorded for all the patients. Results There were no excluded cases. Compared with the ALPDT group, first-pass success rate (92% vs. 64%) was higher, the number of puncture (1.08±0.28 vs. 1.56±0.87) was lower, the procedure time［(7.12±2.42)min vs. (12.20±5.80) min］and amount of bleeding ［(5.48±4.43)mL vs. (11.20±8.41) mL］during operation in USPDT group were less (P<0.05). The decrease in procedural complications was not statistically significant. Conclusion Ultrasound guidance significantly improves the rate of first-pass puncture and puncture accuracy. Less bleeding during operation is observed. These results support wider general use of ultrasound guidance as an additional tool to improve PDT.
|
|
|
|
Corresponding Authors:
Liu Li-xia, E-mail: gwxxo7o8@foxmail.com
|
|
|
|
| ［1］Grant CA, Dempsey G, Harrison J, et al. Tracheo-innominate artery fistula after percutaneous tracheostomy: three case reports and a clinical review［J］. Br J Anaesth, 2006, 96(1):127-131.
［2］Flint AC, Midde R, Rao VA, et al. Bedside ultrasound screening for pretracheal vascular structures may minimize the risks of percutaneous dilatational tracheostomy［J］. Neurocrit Care, 2009, 11(3):372-376.
［3］Rudas M. The role of ultrasound in percutaneous dilatational tracheostomy［J］. Australas J Ultrasound Med, 2012, 15(4):143-148.
［4］Rudas M, Seppelt I. Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients: a systematic review［J］. Crit Care Resusc, 2012, 14(4):297-301.
［5］姜盛春，戴巍，侯丽霞，等. 改良气管切开术在昏迷患者中的临床应用［J］. 中华危重病急救医学， 2013， 25(3): 184.
［6］Byhahn C, Wilke HJ, Halbig S, et al. Percutaneous tracheostomy: Ciaglia Blue rhino versus the basic Ciaglia technique of percutaneous dilational tracheostomy［J］. Anesth Analg, 2000, 91(4):882-886.
［7］郜杨，刘洋，唐荣，等. 改良经皮扩张气管切开术在重症医学科危重患者中的应用研究［J］. 中华危重病急救医学， 2014， 26(2): 106-109．
［8］武巧云，丁维强，王云辉，等. 改良经皮扩张气管切开术在气管插管患者中的应用［J］.中华重症医学电子杂志， 2017， 3(3)：187-190.［9］Bertram S, Emshoff R, Norer B. Ultrasonographic anatomy of the anterior neck: implications for tracheostomy［J］. J Oral Maxillofac Surg, 1995, 53(12):1420-1424.
［10］Sustic A, Zupan Z, Eskinja N, et al. Ultrasonographically guided percutaneous dilatational tracheostomy after anterior cervical spine fixation［J］. Acta Anaesthesiol Scand, 1999, 43(10):1078-1080.
［11］Dinsmore J, Heard AM, Green RJ. The use of ultrasound to guide time-critical cannula tracheotomy when anterior neck airway anatomy is unidentifiable［J］. Eur J Anaesthesiol, 2011, 28(7):506-510.
［12］Pearson NM, Huebner KD, Johnson JN. The use of ultrasound guidance for cricothyroidotomy in three simulated cadaveric difficult airway models ［abstract 159］［J］. Ann Emerg Med, 2011, 58(4):S231.
［13］何许伟，邱倩文，徐俊龙，等. 对比超声辅助与纤维支气管镜辅助下经皮扩张气管切开术的临床应用［J］.中华急诊医学杂志， 2016， 25(7):946-949.
［14］Guinot PG, Zogheib E, Petiot S, et al. Ultrasound-guided percutaneous tracheostomy in critically ill obese patients［J］. Crit Care, 2012, 16(2):R40. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
