• Vi Am Dinh, Siavash Farshidpanah, Samantha Lu, Phillip Stokes, Ara Chrissian, Harsh Shah, Paresh Giri, David Hecht, and H Bryant Nguyen.
• Department of Emergency Medicine (V.A.D., D.H., H.B.N.), Department of Medicine, Division of Pulmonary and Critical Care (V.A.D., S.F., A.C., H.S., P.G., D.H., H.B.N.), and School of Medicine (S.L., P.S.), Loma Linda University, Loma Linda, California USA. vadinh@llu.edu.
• J Ultrasound Med. 2014 Aug 1;33(8):1407-15.

ObjectivesSonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (PDT) has been shown to predict PDT success. In this study, we compared the real-time, long-axis, in-plane approach to the traditional bronchoscopically guided landmark technique.MethodsData were analyzed from a prospectively maintained PDT database at a university tertiary care medical intensive care unit. A convenience sample of adult patients requiring PDT for prolonged mechanical ventilation dependence was enrolled. Critical care fellows, under direct supervision of an attending intensivist, performed all PDTs. Tracheostomy performance from the sonographically guided and landmark techniques was compared.ResultsTwenty-three patients were enrolled: 11 in the sonography group and 12 in the landmark group. Initial midline introducer needle puncture was achieved in 72.7% in the sonography group compared to 8.3% in the landmark group (P< .001). The mean number of introducer needle punctures ± SD was significantly lower in the sonography group compared to the landmark group (1.4 ± 0.7 versus 2.6 ± 0.9; P < .001). The total tracheostomy time was 11.4 ± 4.2 minutes in the sonography group versus 15.3 ± 6.8 minutes in the landmark group (P = .12). Sonography accurately predicted tracheal ring space insertion in 90.9% of patients. Procedural complications did not differ significantly between the groups.ConclusionsPercutaneous dilatational tracheostomy under real-time sonographic guidance using a long-axis approach may increase the rate of midline punctures and decrease the number of needle punctures when compared to the landmark technique. Sonographic guidance can also help guide accurate and efficient placement of a tracheostomy tube into the desired tracheal ring space.© 2014 by the American Institute of Ultrasound in Medicine.

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