Ultrasound-guided percutaneous dilatational tracheostomy: a safe method toavoid cranial misplacement of the tracheostomy tube

The aim of this investigation was to evaluate the role of ultrasonography i n avoiding cranial misplacement of the tracheostomy tube and tracheal ring fractures during percutaneous dilatational tracheostomy (PDT). The tracheas of 26 consecutive ICU patients who had undergone PDT but who later died we re removed en bloc at autopsy. The tracheas were opened along the membranou s portion and the condition of tracheal rings and the site of tracheostomy macroscopically evaluated. The patients were divided in two groups: group A with 15 patients who underwent "blind" PDT and group B with 11 patients wh o underwent ultrasound-guided PDT. In five (33 %) patients from group A, au topsy revealed that the tracheostomy tube was placed between the cricoid ca rtilage and the first tracheal ring (cranial misplacement) and in six (43 % ) patients a fracture of one tracheal ring was found. Cranial misplacement of the tracheostomy tube in patients from group B was not found (P < 0.05) and four (36 %) patients had a broken tracheal ring (P = NS). The authors m aintain that by using ultrasound-guided PDT cranial misplacement of the tra cheostomy tube may be entirely avoided.