Ultrasound-guided percutaneous tracheal puncture: a computer-tomographic controlled study in cadavers

Area of Science:

• Medical Imaging
• Anesthesiology
• Surgical Procedures

Background:

• Ultrasound guidance is increasingly utilized in anesthesia for tissue identification and accurate needle placement.
• This study investigates the utility of ultrasound for guiding dilatational tracheostomy procedures.

Purpose of the Study:

• To evaluate the effectiveness of ultrasound-guided tracheal puncture in human cadavers for dilatational tracheostomy.
• To assess the accuracy of guidewire placement using an in-plane, longitudinal ultrasound approach.

Main Methods:

• Nine human cadavers underwent ultrasound-guided tracheal puncture using an in-plane, longitudinal approach.
• Following needle insertion and confirmation of air/fluid aspiration, a cricothyroidotomy guidewire was advanced.
• Computer tomography (CT) imaging was performed for post-procedure assessment of wire placement.

Main Results:

• Successful tracheal puncture and guidewire insertion were achieved in all nine cadavers (10 attempts total).
• Eight out of nine successful wire placements were on the defined midline.
• One wire was not placed on the midline, and CT did not detect this deviation.

Conclusions:

• Ultrasound guidance can facilitate successful tracheal puncture for dilatational tracheostomy.
• The in-plane, longitudinal ultrasound approach does not ensure exact midline puncture.
• This technique does not reliably detect misplaced guidewires during the procedure.