Ultrasound Guided Percutaneous Tracheostomy

Overview

Use of the ultrasound before, during and after percutaneous tracheostomy allows us great advantages; anatomy of the pre and paratracheal region and displaying potential aberrant vessels, and so the needle and dilator to move away from risk areas and ensure the prevention of possible vascular complications. Measuring the distance from the skin into the trachea can be done and this allows us to choose the average size tracheostomy tube. The aim of this study, In the process of applying percutaneous tracheostomy, to compare the reliability of the traditional landmark method, ultrasound-guided long axis in plane application and ultrasound-guided short axis out of plane application.

Full Title of Study: “Comparison of 3 Techniques for Percutaneous Tracheostomy : Traditional Marking Technique, Ultrasonography Guided Long Axis Approach and Short Axis Approach”

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Parallel Assignment
    • Primary Purpose: Supportive Care
    • Masking: None (Open Label)
  • Study Primary Completion Date: November 2016

Interventions

  • Procedure: ultrasound-guided percutaneous tracheostomy
    • to compare the reliability of the traditional landmark method, ultrasound-guided long axis in plane applications and ultrasound-guided short-axis out of plane application in the implementation process percutaneous tracheostomy

Arms, Groups and Cohorts

  • No Intervention: landmark group
    • percutaneous tracheostomy with traditional landmark technique
  • Active Comparator: ultrasound-guided long axis group
    • percutaneous tracheostomy will be implemented In the real-time ultrasound-guided in plane technique
  • Active Comparator: ultrasound-guided short axis group
    • percutaneous tracheostomy will be implemented In the real-time ultrasound-guided out of plane technique

Clinical Trial Outcome Measures

Primary Measures

  • The success of the first application
    • Time Frame: ten minute
  • successful tube placement rate
    • Time Frame: fifteen minüte
  • Complications during the procedure
    • Time Frame: one month

Secondary Measures

  • The number of puncture
    • Time Frame: ten minute
  • total tracheostomy application time
    • Time Frame: fifteen minute
  • Early and late complications after the process
    • Time Frame: one month

Participating in This Clinical Trial

Inclusion Criteria

  • hospitalized patients in intensive care – the decision to open percutaneous tracheostomy – over 18 years Exclusion Criteria:

  • under 18 years – Patients with high or unstable intracranial pressure – Patients with severe coagulation disorders – Patients attached collar – hemodynamically unstable patients, despite the use of high doses of vasoactive drugs – patients with infections in tracheostomy area

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Erzincan University
  • Provider of Information About this Clinical Study
    • Principal Investigator: ILKE KUPELI, assist. prof. – Erzincan University
  • Overall Official(s)
    • İlke kupeli, Principal Investigator, Erzincan University

Citations Reporting on Results

Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care. 2006;10(2):R55. doi: 10.1186/cc4887.

Cheung NH, Napolitano LM. Tracheostomy: epidemiology, indications, timing, technique, and outcomes. Respir Care. 2014 Jun;59(6):895-915; discussion 916-9. doi: 10.4187/respcare.02971.

Simon M, Metschke M, Braune SA, Puschel K, Kluge S. Death after percutaneous dilatational tracheostomy: a systematic review and analysis of risk factors. Crit Care. 2013 Oct 29;17(5):R258. doi: 10.1186/cc13085.

McCormick B, Manara AR. Mortality from percutaneous dilatational tracheostomy. A report of three cases. Anaesthesia. 2005 May;60(5):490-5. doi: 10.1111/j.1365-2044.2005.04137.x.

Flint AC, Midde R, Rao VA, Lasman TE, Ho PT. Bedside ultrasound screening for pretracheal vascular structures may minimize the risks of percutaneous dilatational tracheostomy. Neurocrit Care. 2009 Dec;11(3):372-6. doi: 10.1007/s12028-009-9259-z. Epub 2009 Aug 13.

Rudas M. The role of ultrasound in percutaneous dilatational tracheostomy. Australas J Ultrasound Med. 2012 Nov;15(4):143-148. doi: 10.1002/j.2205-0140.2012.tb00197.x. Epub 2015 Dec 31.

Chacko J, Nikahat J, Gagan B, Umesh K, Ramanathan M. Real-time ultrasound-guided percutaneous dilatational tracheostomy. Intensive Care Med. 2012 May;38(5):920-1. doi: 10.1007/s00134-012-2514-3. Epub 2012 Feb 17. No abstract available.

Rajajee V, Fletcher JJ, Rochlen LR, Jacobs TL. Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study. Crit Care. 2011;15(1):R67. doi: 10.1186/cc10047. Epub 2011 Feb 22.

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