title: Bedside ultrasound screening for pretracheal vascular structures may minimize the risks of percutaneous dilatational tracheostomy.
abstract: OBJECTIVE
  Percutaneous dilatational tracheostomy (PDT) continues to gain in popularity as a bedside method for tracheostomy placement in the intensive care unit. Here, we present a description of ultrasound technique and two case examples to show the utility of bedside ultrasound screening to select patients with appropriate anatomy for PDT.
  
  
  METHODS
  We have instituted a protocol at our institution to use bedside screening ultrasound to confirm appropriate anatomy prior to PDT. In this report, we present our ultrasound methodology and present two cases with clear correlations between screening ultrasound findings and intraoperative findings.
  
  
  RESULTS
  We describe an easily applied method for pretracheal ultrasound screening. To show the utility of this screening technique, we then present two example cases showing pretracheal vascular structures seen on ultrasound and during open operative exploration.
  
  
  CONCLUSIONS
  Bedside ultrasound screening allows for easy identification of pretracheal vascular structures that might pose a hemorrhage risk during PDT.
authors.affiliation: Neurocritical Care and Pulmonary Critical Care, Head and Neck Surgery, Kaiser Permanente, 1150 Veterans Blvd, Redwood City, CA 94063, USA. alexander.flint@gmail.com
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Flint
authors.forename: Raghu
authors.initials: R
authors.lastname: Midde
authors.forename: Vivek A
authors.initials: VA
authors.lastname: Rao
authors.forename: Todd E
authors.initials: TE
authors.lastname: Lasman
authors.forename: Philip T
authors.initials: PT
authors.lastname: Ho
mesh_terms: D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D004106:Dilatation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000628:therapy*; D019095:Point-of-Care Systems; D012128:Respiratory Distress Syndrome / Q000628:therapy*; D012307:Risk Factors; D014132:Trachea / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D018084:Ultrasonography, Interventional
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