title: Ultrasound-guided percutaneous tracheal puncture: a computer-tomographic controlled study in cadavers.
abstract: BACKGROUND
  Ultrasound-guided techniques are increasingly used in anaesthetic practice to identify tissues beneath the skin and to increase the accuracy of placement of needles close to targeted structures. To examine ultrasound's usefulness for dilatational tracheostomy, we performed ultrasound-guided tracheal punctures in human cadavers followed by computer-tomographic (CT) control.
  
  
  METHODS
  The trachea of nine cadavers was punctured using an in-plane approach with a longitudinal ultrasound visualization of the trachea. As soon as a loss of resistance was felt, or air/fluid could be aspirated into the attached syringe, the syringe was disconnected and the ultrasound transducer set aside. Thereafter, a cricothyroidotomy guidewire was inserted through the needle into the trachea. The needle was then removed, leaving the wire in place and a control CT imaging of the neck and the chest was performed. Primary outcome was successful wire insertion into the trachea.
  
  
  RESULTS
  Tracheal puncture and wire insertion was successful in eight of nine cadavers at the first attempt and in one at the second attempt (total of 10 puncture attempts, nine successful). In eight of nine successfully inserted wires, the wire was placed on the defined midline.
  
  
  CONCLUSIONS
  Ultrasound guidance can facilitate successful tracheal puncture. However, combining an in-plane approach with a longitudinal ultrasound visualization of the trachea neither guarantees an exact midline puncture nor allows detection of a misplaced guidewire.
authors.affiliation: University Department of Anaesthesiology and Pain Therapy, Inselspital.
authors.forename: M
authors.initials: M
authors.lastname: Kleine-Brueggeney
authors.forename: R
authors.initials: R
authors.lastname: Greif
authors.forename: S
authors.initials: S
authors.lastname: Ross
authors.forename: U
authors.initials: U
authors.lastname: Eichenberger
authors.forename: B
authors.initials: B
authors.lastname: Moriggl
authors.forename: A
authors.initials: A
authors.lastname: Arnold
authors.forename: C
authors.initials: C
authors.lastname: Luyet
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014132:Trachea / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014139:Tracheostomy / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*