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Harutyunyan R, Jeffries SD, Morse J, Hemmerling TM. Beyond the Echo: The Evolution and Revolution of Ultrasound in Anesthesia. Anesth Analg 2024; 138:369-375. [PMID: 38215715 DOI: 10.1213/ane.0000000000006834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Abstract
This article explores the evolving role of ultrasound technology in anesthesia. Ultrasound emerged decades ago, offering clinicians noninvasive, economical, radiation-free, and real-time imaging capabilities. It might seem that such an old technology with apparent limitations might have had its day, but this review discusses both the current applications of ultrasound (in nerve blocks, vascular access, and airway management) and then, more speculatively, shows how integration of advanced ultrasound modalities such as contrast-enhanced imaging with virtual reality (VR), or nanotechnology can alter perioperative patient care. This article will also explore the potential of robotics and artificial intelligence (AI) in augmenting ultrasound-guided anesthetic procedures and their implications for medical practice and education.
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Affiliation(s)
- Robert Harutyunyan
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Sean D Jeffries
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Joshua Morse
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
| | - Thomas M Hemmerling
- From the Department of Experimental Surgery, McGill University Health Center, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
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Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: Point of care in children-The time is now. Paediatr Anaesth 2020; 30:347-352. [PMID: 31901216 DOI: 10.1111/pan.13823] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/31/2019] [Accepted: 01/02/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Point-of-care ultrasonography of the airway is becoming a first-line noninvasive adjunct assessment tool of the pediatric airway. It is defined as a focused and goal-directed portable ultrasonography brought to the patient and performed and interpreted on the spot by the provider. Successful use requires a thorough understanding of airway anatomy and ultrasound experience. AIMS To outline the many benefits, and some limitations, of airway ultrasonography in the clinical and perioperative setting. MATERIALS AND METHODS Expert review of the recent literature. RESULTS Ultrasound assessment of the airway may provide the clinician with valuable information that is specific to the individual airway static and dynamic anatomy of the patient. Ultrasound can help identify vocal cord dysfunction and pathology, assess airway size, predict the appropriate diameter of endotracheal and tracheostomy tubes, differentiate tracheal from esophageal intubation, localize the cricothyroid membrane for emergency airway access and identify tracheal rings for US-guided tracheostomy. Ultrasonography is also a great tool for the intraoperative diagnosis of a pneumothorax, the visualization of the movement of the diaphragms, and quantifying the amount of gastric content. Ultrasonography signs, tips, and pearls that allow these diagnoses are highlighted. The major disadvantage of ultrasonography remains interobserver variability, and operator dependence, as it requires specific training and experience. CONCLUSION Although it is not standard of care yet, there is significant potential for the integration of ultrasound technology into the routine care of the airway.
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Affiliation(s)
- Sam J Daniel
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Anesthesiology, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Tobial McHugh
- Department of Pediatric Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada.,Department of Otolaryngology-Head and Neck Surgery, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
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Naina P, Syed KA, Irodi A, John M, Varghese AM. Pediatric tracheal dimensions on computed tomography and its correlation with tracheostomy tube sizes. Laryngoscope 2019; 130:1316-1321. [PMID: 31228208 DOI: 10.1002/lary.28141] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 05/30/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Age-based formulas for selecting the appropriate size of tracheostomy tubes in children are based on data on tracheal dimensions. This study aims to measure the tracheal dimensions of Indian children by computerized tomography (CT) and to compare this with the dimensions of age-appropriate tracheostomy tubes. METHODS CT scans of children aged less than 16 years that were taken for indications other than respiratory distress were included. Tracheal diameters at the tracheostomy point and tracheal length from the tracheostomy point to the carina were calculated from the scans. These dimensions were correlated with age, weight, and height. The measurement on the CT scan was used to predict the appropriate size of tracheostomy tube, which was compared with the tracheostomy tube sizes. RESULTS Two hundred and fourteen CT scans of children aged below 16 years were included in the study. On multiple logistic regression analysis, tracheal diameter correlated well with age and weight (P = 0.04 and 0.001, respectively), whereas tracheal length correlated well with age and height of the child (P = 0.03 and 0 < 0.001, respectively). On comparison with dimensions of the tracheostomy tube, tracheal diameter correlated well, and the length was found to be longer than needed to prevent endobronchial intubation. The regression value was used to predict the size of an ideal tracheostomy tube. CONCLUSION Tracheal diameter of Indian children correlates well with the outer diameter of age-appropriate tracheostomy tubes, but the length of these tubes is longer than the ideal length. This would necessitate a change in the design of these tubes. LEVEL OF EVIDENCE 2b Laryngoscope, 130:1316-1321, 2020.
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Affiliation(s)
- P Naina
- Department of ENT, Christian Medical College, Vellore, India
| | | | - Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, India
| | - Mary John
- Department of ENT, Christian Medical College, Vellore, India
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Current Concepts in the Management of the Difficult Pediatric Airway. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00319-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Lages N, Vieira D, Dias J, Antunes C, Jesus T, Santos T, Correia C. Acesso às vias aéreas guiado por ultrassom. Braz J Anesthesiol 2018; 68:624-632. [DOI: 10.1016/j.bjan.2018.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 05/06/2018] [Accepted: 06/22/2018] [Indexed: 01/17/2023] Open
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Lages N, Vieira D, Dias J, Antunes C, Jesus T, Santos T, Correia C. [Ultrasound guided airway access]. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2018; 68. [PMID: 30245096 PMCID: PMC9391688 DOI: 10.1016/j.bjane.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Ultrasound has increasingly growing applications in anesthesia. This procedure has proven to be a novel, non-invasive and simple technique for the upper airway management, proving to be a useful tool, not only in the operating room but also in the intensive care unit and emergency department. Indeed, over the years mounting evidence has showed an increasing role of ultrasound in airway management. In this review, the authors will discuss the importance of ultrasound in the airway preoperative assessment as a way of detecting signs of difficult intubation or to define the type and/or size of the endotracheal tube as well as to help airway procedures such as endotracheal intubation, cricothyrotomy, percutaneous tracheal intubation, retrograde intubation as well as the criteria for extubation.
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Affiliation(s)
- Neusa Lages
- Centro Hospitalar do Alto Ave, Guimarães, Portugal,Corresponding author.
| | - Diana Vieira
- Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Joana Dias
- Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | | | - Tiago Jesus
- Centro Hospitalar do Alto Ave, Guimarães, Portugal
| | - Telmo Santos
- Centro Hospitalar Trás Montes e Alto Douro, Vila Real, Portugal
| | - Carlos Correia
- Centro Hospitalar Trás Montes e Alto Douro, Vila Real, Portugal
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Point-of-care ultrasound (POCUS) of the upper airway. Can J Anaesth 2018; 65:473-484. [PMID: 29349733 DOI: 10.1007/s12630-018-1064-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 12/04/2017] [Accepted: 12/16/2017] [Indexed: 12/25/2022] Open
Abstract
Airway management is a critical skill in the practice of several medical specialities including anesthesia, emergency medicine, and critical care. Over the years mounting evidence has showed an increasing role of ultrasound (US) in airway management. The objective of this narrative review is to provide an overview of the indications for point-of-care ultrasound (POCUS) of the upper airway. The use of US to guide and assist clinical airway management has potential benefits for both provider and patient. Ultrasound can be utilized to determine airway size and predict the appropriate diameter of single-lumen endotracheal tubes (ETTs), double-lumen ETTs, and tracheostomy tubes. Ultrasonography can differentiate tracheal, esophageal, and endobronchial intubation. Ultrasonography of the neck can accurately localize the cricothyroid membrane for emergency airway access and similarly identify tracheal rings for US-guided tracheostomy. In addition, US can identify vocal cord dysfunction and pathology before induction of anesthesia. A rapidly growing body of evidence showing ultrasonography used in conjunction with hands-on management of the airway may benefit patient care. Increasing awareness and use of POCUS for many indications have resulted in technologic advancements and increased accessibility and portability. Upper airway POCUS has the potential to become the first-line non-invasive adjunct assessment tool in airway management.
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Two methods for teaching basic upper airway sonography. J Clin Anesth 2016; 31:166-72. [DOI: 10.1016/j.jclinane.2016.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 01/29/2023]
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Abstract
Background: The use of ultrasound to evaluate cervical anatomy and to guide tracheal puncture in real-time has been advocated to improve safety and efficacy of percutaneous dilatational tracheostomy (PDT) in intensive care. Objective: To review the potential role, attributed theoretical benefits and supporting literature for ultrasound during PDT. Results: A significant number of mostly observational studies and case series support this modality. Real-time guidance enables clear visualisation of anatomical landmarks and results in a consistently high success and low complication rate, with appropriate positioning of the tracheal puncture. Recognition of unconventional vascular anatomy enables selection of an appropriate alternative puncture site or an elective open surgical approach. Conclusion: Current literature supports that using ultrasound for percutaneous tracheostomy is quick, safe, reliable and offers a plausible advantage over the traditional landmark guided procedure, especially in select patient groups, such as those who are morbidly obese or have difficult to palpate cervical anatomy.
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Affiliation(s)
- Máté Rudas
- Intensive Care Unit Nepean Hospital PO Box 63 Penrith New South Wales Australia
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Yavuz A, Yılmaz M, Göya C, Alimoglu E, Kabaalioglu A. Advantages of US in Percutaneous Dilatational Tracheostomy: Randomized Controlled Trial and Review of the Literature. Radiology 2014; 273:927-36. [DOI: 10.1148/radiol.14140088] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Gobatto ALN, Besen BAMP, Tierno PFGMM, Mendes PV, Cadamuro F, Joelsons D, Melro L, Park M, Malbouisson LMS. Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: a retrospective cohort study. J Crit Care 2014; 30:220.e13-7. [PMID: 25306240 DOI: 10.1016/j.jcrc.2014.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/13/2014] [Accepted: 09/14/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopic guidance. Recently, ultrasound (US) has emerged as a new safety adjunct tool to increase the efficacy of PDT. However, the available data are limited to case series without any control group. Hence, a retrospective cohort study was designed to evaluate the efficacy of US-guided PDT compared with bronchoscopy-guided PDT. METHODS All patients who were submitted to PDT after the standardization of US-guided PDT technique in our institution were analyzed. Demographic and procedure-related variables, complications, and clinical outcomes were collected and compared in patients undergoing US- or bronchoscopy-guided PDT. RESULTS Sixty patients who had been submitted to PDT were studied, including 11 under bronchoscopy guidance and 49 under US guidance. No surgical conversion was necessary in any of the procedures, and bronchoscopy assistance was only required in 1 case in the US group. The procedure length was shorter in the US group than in the bronchoscopy group (12 vs 15 minutes, P = .028). None of the patients had any major complications. The minor complication rates were not significantly different between the groups, nor was the probability of breathing without assistance within 28 days, intensive care unit length of stay, or hospital mortality. CONCLUSION Ultrasound-guided PDT is effective, safe, and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided PDT.
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Affiliation(s)
- André Luiz Nunes Gobatto
- Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Surgical Intensive Care Unit, Anesthesiology Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
| | | | | | - Pedro Vitale Mendes
- Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Filipe Cadamuro
- Trauma Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Daniel Joelsons
- Intensive Care Unit, Infectious Disease Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Livia Melro
- Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Park
- Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Luiz Marcelo Sá Malbouisson
- Trauma Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Surgical Intensive Care Unit, Anesthesiology Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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Rudas M, Seppelt I, Herkes R, Hislop R, Rajbhandari D, Weisbrodt L. Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:514. [PMID: 25231604 PMCID: PMC4189189 DOI: 10.1186/s13054-014-0514-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 08/28/2014] [Indexed: 11/10/2022]
Abstract
Introduction Long-term ventilated intensive care patients frequently require tracheostomy. Although overall risks are low, serious immediate and late complications still arise. Real-time ultrasound guidance has been proposed to decrease complications and improve the accuracy of the tracheal puncture. We aimed to compare the procedural safety and efficacy of real-time ultrasound guidance with the traditional landmark approach during percutaneous dilatational tracheostomy (PDT). Methods A total of 50 patients undergoing PDT for clinical indications were randomly assigned, after obtaining informed consent, to have the tracheal puncture procedure carried out using either traditional anatomical landmarks or real-time ultrasound guidance. Puncture position was recorded via bronchoscopy. Blinded assessors determined in a standardised fashion the deviation of the puncture off midline and whether appropriate longitudinal position between the first and fourth tracheal rings was achieved. Procedural safety and efficacy data, including complications and number of puncture attempts required, were collected. Results In total, 47 data sets were evaluable. Real-time ultrasound guidance resulted in significantly more accurate tracheal puncture. Mean deviation from midline was 15 ± 3° versus 35 ± 5° (P = 0.001). The proportion of appropriate punctures, defined a priori as 0 ± 30° from midline, was significantly higher: 20 (87%) of 23 versus 12 (50%) of 24 (RR = 1.74; 95% CI = 1.13 to 2.67; P = 0.006). First-pass success rate was 20 (87%) of 23 in the ultrasound group and 14 (58%) of 24 in the landmark group (RR = 1.49; 95% CI = 1.03 to 2.17; P = 0.028). The observed decrease in procedural complications was not statistically significant: 5 (22%) of 23 in the ultrasound group versus 9 (37%) of 24 in the landmark group (RR = 0.58; 95% CI = 0.23 to 1.47; P = 0.24). Conclusions Ultrasound guidance significantly improved the rate of first-pass puncture and puncture accuracy. Fewer procedural complications were observed; however, this did not reach statistical significance. These results support wider general use of real-time ultrasound guidance as an additional tool to improve PDT. Trial registration Australian New Zealand Clinical Trials Registry ID: ACTRN12611000237987 (registered 4 March 2011) Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0514-0) contains supplementary material, which is available to authorized users.
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Kristensen MS, Teoh WH, Graumann O, Laursen CB. Ultrasonography for clinical decision-making and intervention in airway management: from the mouth to the lungs and pleurae. Insights Imaging 2014; 5:253-79. [PMID: 24519789 PMCID: PMC3999368 DOI: 10.1007/s13244-014-0309-5] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 12/20/2013] [Accepted: 01/10/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To create a state-of-the-art overview of the new and expanding role of ultrasonography in clinical decision-making, intervention and management of the upper and lower airways, that is clinically relevant, up-to-date and practically useful for clinicians. METHODS This is a narrative review combined with a structured Medline literature search. RESULTS Ultrasonography can be utilised to predict airway difficulty during induction of anaesthesia, evaluate if the stomach is empty or possesses gastric content that poses an aspiration risk, localise the essential cricothyroid membrane prior to difficult airway management, perform nerve blocks for awake intubation, confirm tracheal or oesophageal intubation and facilitate localisation of tracheal rings for tracheostomy. Ultrasonography is an excellent diagnostic tool in intraoperative and emergency diagnosis of pneumothorax. It also enables diagnosis and treatment of interstitial syndrome, lung consolidation, atelectasis, pleural effusion and differentiates causes of acute breathlessness during pregnancy. Patient safety can be enhanced by performing procedures under ultrasound guidance, e.g. thoracocentesis, vascular line access and help guide timing of removal of chest tubes by quantification of residual pneumothorax size. CONCLUSIONS Ultrasonography used in conjunction with hands-on management of the upper and lower airways has multiple advantages. There is a rapidly growing body of evidence showing its benefits. TEACHING POINTS • Ultrasonography is becoming essential in management of the upper and lower airways. • The tracheal structures can be identified by ultrasonography, even when unidentifiable by palpation. • Ultrasonography is the primary diagnostic approach in suspicion of intraoperative pneumothorax. • Point-of-care ultrasonography of the airways has a steep learning curve. • Lung ultrasonography allows treatment of interstitial syndrome, consolidation, atelectasis and effusion.
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Affiliation(s)
- Michael S Kristensen
- Department of Anaesthesia, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100, Denmark,
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KRISTENSEN MS. Ultrasonography in the management of the airway. Acta Anaesthesiol Scand 2011; 55:1155-73. [PMID: 22092121 DOI: 10.1111/j.1399-6576.2011.02518.x] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2011] [Indexed: 12/19/2022]
Abstract
In this study, it is described how to use ultrasonography (US) for real-time imaging of the airway from the mouth, over pharynx, larynx, and trachea to the peripheral alveoli, and how to use this in airway management. US has several advantages for imaging of the airway - it is safe, quick, repeatable, portable, widely available, and it must be used dynamically for maximum benefit in airway management, in direct conjunction with the airway management, i.e. immediately before, during, and after airway interventions. US can be used for direct observation of whether the tube enters the trachea or the esophagus by placing the ultrasound probe transversely on the neck at the level of the suprasternal notch during intubation, thus confirming intubation without the need for ventilation or circulation. US can be applied before anesthesia induction and diagnose several conditions that affect airway management, but it remains to be determined in which kind of patients the predictive value of such an examination is high enough to recommend this as a routine approach to airway management planning. US can identify the croicothyroid membrane prior to management of a difficult airway, can confirm ventilation by observing lung sliding bilaterally and should be the first diagnostic approach when a pneumothorax is suspected intraoperatively or during initial trauma-evaluation. US can improve percutaneous dilatational tracheostomy by identifying the correct tracheal-ring interspace, avoiding blood vessels and determining the depth from the skin to the tracheal wall.
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Affiliation(s)
- M. S. KRISTENSEN
- Department of Anaesthesia and Operating Theatre Services 4231; Center of Head and Orthopaedics; Copenhagen University Hospital; Rigshospitalet; Denmark
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Oram J, Bodenham A. Choice of Tracheostomy Tube: Does One Size Fit All? Intensive Care Med 2009. [DOI: 10.1007/978-0-387-77383-4_30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Marciniak B, Fayoux P, Hébrard A, Krivosic-Horber R, Engelhardt T, Bissonnette B. Airway management in children: ultrasonography assessment of tracheal intubation in real time? Anesth Analg 2009; 108:461-5. [PMID: 19151273 DOI: 10.1213/ane.0b013e31819240f5] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pediatric tracheal intubation requires considerable expertise and can represent a challenge to many anesthesiologists. Confirmation of correct tracheal tube position relies on direct visualization or indirect measures, such as auscultation and capnography. These methods have varying sensitivity and specificity, especially in the infant and young child. Ultrasonography is noninvasive and is becoming more readily available to the anesthesiologist. In this study, we investigated the characteristic real-time ultrasonographic findings of the normal pediatric airway during tracheal intubation and its suitability for clinical use. METHODS Thirty healthy children with normal airways requiring tracheal intubation were studied. Ultrasonographic measurements of the pediatric airway during tracheal intubation under deep inhaled anesthesia were performed using a Sonosite Titan (Sonosite, Bothell, WA) scanner while recording characteristic images during this process. Correct tracheal tube placement was further confirmed using auscultation and satisfactory end-tidal capnography. RESULTS The mean (+/- sd) age of studied patients was 48 +/- 37 mo, weight was 19.7. +/- 8.6 kg and the sex ratio (m/f) was 1:2. Successful tracheal intubation was verified using the following criteria: 1) identification of the trachea and tracheal rings, 2) visualization of vocal cords, 3) widening of glottis as the tracheal tube passes through, and 4) tracheal tube position above carina and demonstration of movement of the chest wall visceroparietal pleural interface (i.e., sliding sign) after manual ventilation of the lungs. One esophageal intubation was readily recognized by visualization of the tube in the left paratracheal space. CONCLUSION This study describes characteristic ultrasonographic findings of the pediatric airway during tracheal intubation. It suggests that ultrasonography may be useful for airway management in children.
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Affiliation(s)
- Bruno Marciniak
- Pôle d'Anesthésie Réanimation, Hôpital Jeanne de Flandre, CHRU, Rue Eugène Aviné, 59037 Lille Cedex France.
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Abstract
Long-term tracheostomy in infants and children is associated with significant morbidity. The majority of paediatric patients experience tracheostomy-related complications during cannulation and/or after decannulation. A large proportion of these complications are, however, preventable or may be minimised by good tracheostomy care and clinical evaluation of the patients at regular intervals, tailored to the needs of the individual child. By and large, infants and children benefit from a specialist tracheostomy service. In this article, we review different aspects of hospital-based care, covering a wide range of topics including the selection of tracheostomy tubes and adjuncts, clinical evaluation, speech/communication, and late complications and their prevention.
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Affiliation(s)
- Ernst Eber
- Respiratory and Allergic Disease Division, Paediatric Department, Medical University of Graz, Auenbruggerplatz 30, A-8036 Graz, Austria.
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Behl S, Watt JWH. Prediction of tracheostomy tube size for paediatric long-term ventilation: an audit of children with spinal cord injury. Br J Anaesth 2005; 94:88-91. [PMID: 15486000 DOI: 10.1093/bja/aeh296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are no published data to predict tracheostomy tube size as growth proceeds in children requiring long-term ventilation. METHODS A retrospective audit was undertaken of children having long-term ventilation, managed from the Southport spinal injuries unit. The dates of step-up in size of tracheostomy tube were noted together with the tube inside and outside diameters (ID and OD) and the lateral tracheal diameter. The data were aggregated for each increment in tube size to calculate the Pearson correlation coefficients for age and weight of the children. Linear regression was then used to generate predictive equations based on age and weight. RESULTS Out of 12 children, data from seven boys and two girls, with a mean age of 5.9 (range 1.5-13.75) yr, were obtained. Average length of follow-up was 7 yr, with an average of 3.5 tube changes per patient equating to a larger tube every 2 yr. The inside and outside tracheal tube diameters, as well as the lateral tracheal diameter, correlated significantly with age and weight (P<0.01). The appropriate tracheostomy tube internal diameter is conveniently expressed by the formula: ID mm=age yr/3 + 3.5 CONCLUSIONS The step-up in size of the tracheostomy tube as growth proceeds should be undertaken as a planned procedure at least every 2 yr to avoid nocturnal desaturation. Age appears to be a convenient and reliable predictor.
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Affiliation(s)
- S Behl
- Department of Anaesthesia and Spinal Injuries Centre, Southport and Ormskirk Hospital NHS Trust, Town Lane, Southport PR8 6PN, UK
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