Department of Anesthesiology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan.
Department of Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu City, Taiwan; Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan.
J Crit Care. 2018 Dec;48:112-117. doi: 10.1016/j.jcrc.2018.08.010. Epub 2018 Aug 18.
The saline-filled endotracheal tube (ETT) cuff can be easily identified under cervical ultrasound and can serve as an ideal puncture target during percutaneous dilatational tracheostomy (PDT). The authors present their initial experience with this novel technique.
The records of 38 consecutive critically ill patients who underwent saline-filled cuff puncture PDT between October 2016 and December 2017 were retrospectively reviewed. The saline-filled ETT cuff was easily identified using ultrasound. Ultrasound-guided puncture into the cuff, followed by an inward-push of the ETT through the tube exchanger, facilitated accurate passage of the guidewire through the needle tip into the tracheal lumen.
Of 38 consecutive procedures, 37 (97.4%) were performed successfully, with only one converted to surgical tracheostomy due to guidewire displacement. The median procedure time was 8 min. There were no complications, such as accidental extubation, major bleeding, or posterior tracheal wall laceration or pneumothorax, and no procedure-related mortalities.
PDT performed using a saline-filled cuff as the ultrasound-guided puncture target and an endotracheal tube exchanger is feasible, and appeared to be easier to perform than standard PDT. Larger studies are required to confirm the safety and benefits of this technique.
在颈部超声下，可轻易识别充满生理盐水的气管内导管（ETT）套囊，且在经皮扩张气管切开术（PDT）中可作为理想的穿刺目标。本文介绍了该新技术的初步应用经验。
回顾性分析了 2016 年 10 月至 2017 年 12 月期间连续 38 例接受生理盐水充盈套囊穿刺 PDT 的危重症患者的记录。使用超声可轻易识别充满生理盐水的 ETT 套囊。超声引导下穿刺至套囊内，然后通过气管内导管交换器将 ETT 向内推送，可使导丝经针尖准确地进入气管腔。
38 例连续操作中，37 例（97.4%）操作成功，仅 1 例因导丝移位而转为手术气管切开术。中位手术时间为 8 分钟。无意外拔管、大出血、后气管壁撕裂或气胸等并发症，也无与操作相关的死亡病例。
使用充满生理盐水的套囊作为超声引导穿刺目标，以及使用气管内导管交换器进行 PDT 是可行的，且似乎比标准 PDT 更容易操作。需要更大规模的研究来证实该技术的安全性和益处。
