title: Ultrasound imaging for endotracheal tube repositioning during percutaneous tracheostomy in a cadaver model: a potential teaching modality.
abstract: BACKGROUND
  Percutaneous tracheostomy (PCT) is a widely accepted method for the insertion of a tracheostomy tube in a critically ill patient. Because a patient's preexisting endotracheal tube is manipulated during the procedure, premature extubation with potential catastrophic loss of airway control is a risk. As portable ultrasound imaging becomes increasingly useful in the critical care setting, investigations continue to determine the safety of PCT with the technology.
  
  
  METHODS
  Introduction of an endotracheal tube in the proximal airway under bronchoscopic guidance was performed in a cadaver. The endotracheal tube cuff was inflated with agitated water and visualized using a portable ultrasound device. The endotracheal tube cuff was then withdrawn under ultrasound guidance to the proximal trachea.
  
  
  RESULTS
  Sonographic visualization of the endotracheal tube cuff within the trachea was successfully achieved. The endotracheal tube was withdrawn to the proximal trachea, and satisfactory needle cannulation of the trachea was performed.
  
  
  CONCLUSIONS
  Ultrasound can be used to identify an endotracheal tube cuff during a PCT, and repositioning the endotracheal tube under ultrasound guidance could decrease the risk of accidental extubation. This approach to PCT may be used in a cadaveric model to teach anatomy and procedural skills to learners and possibly further adopted in real patients to improve the overall safety profile of the PCT procedure.
authors.affiliation: Trauma Services, Iowa Methodist Medical Center, Des Moines, IA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Tonui
authors.affiliation: Department of Radiology, Iowa Methodist Medical Center, Des Moines, IA.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Nish
authors.affiliation: Medical Education Services, Iowa Methodist Medical Center, Des Moines, IA ; Department of Internal Medicine, Carver College of Medicine, University of Iowa, Des Moines, IA.
authors.forename: Hayden L
authors.initials: HL
authors.lastname: Smith
authors.affiliation: Department of Internal Medicine, Carver College of Medicine, University of Iowa, Des Moines, IA.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Letendre
authors.affiliation: College of Osteopathic Medicine, Des Moines University, Des Moines, IA.
authors.forename: Dustin R
authors.initials: DR
authors.lastname: Portela
keywords: Airway extubation; cadaver; tracheostomy; ultrasonography