Comparison Between Real-Time Ultrasound-Guided Percutaneous Tracheostomy and Surgical Tracheostomy in Critically Ill Patients

Figure 2

Real time ultrasound-guided percutaneous dilatational tracheostomy. After marking the cricoid cartilage and sternal notch, local anesthesia was injected superficial to the thyroid isthmus. Under sagittal conversion of the ultrasound probe, the ET tube was repositioned to an appropriate level to prevent tube puncture. The guide needle was inserted carefully to avoid damaging the cervical vasculature in the axial ultrasound view, followed by air regurgitation and insertion of the guidewire. The T-tube could be inserted along the guidewire following stepwise multiple dilatations using the Ciaglia Blue Rhino tracheostomy kit. I: thyroid isthmus, ET tube: endotracheal tube, T-tube: tracheostomy tube.