• Chien-Hung Lin, Shun-Mao Yang, Xu-Heng Chiang, Jen-Hao Chuang, Huan-Jang Ko, and Pei-Ming Huang.
• Department of Anesthesiology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan.
• J Crit Care. 2018 Dec 1; 48: 112-117.

PurposeThe 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.Materials And MethodsThe 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.ResultsOf 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.ConclusionsPDT 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.Copyright © 2018 Elsevier Inc. All rights reserved.

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