Clinical study of accurate repositioning of endotracheal tube in percutaneous dilatational tracheotomy for patients undergoing mechanical ventilation

Abstract

Objective To explore the feasibility and safety of ultrasound-guided endotracheal tube (ETT) withdrawal and repositioning during percutaneous dilatational tracheostomy (PDT) in patients with mechanical ventilation. Methods One hundred and twenty patients undergoing general anesthesia were selected and the incisor-glottic distance was measured under direct vision by the laryngoscope. Subsequently, eighty patients scheduled to undergo PDT were selected and divided into conventional incision group (group T) and ultrasound-guided group (group U) by Excel random number generation method, with 40 cases in each group. The puncture site was identified though anatomical landmarks in group T and real-time ultrasound guidance in group U respectively. Before incision, ETT was withdrawn to 20 cm (the incisors correspond to the ETT scale) in group T whereas the cuff of ETT was retracted to the level of the cricoid cartilage under ultrasound guidance in group U. The one-time success rate of trachea puncture and guide wire insertion were recorded and compared. The occurrence rate of ETT and cuff puncture, the rate of premature loss of airway control, operation time, the incidence of SpO2 less than 90% in the process of PDT and the success rate of percutaneous tracheotomy tube (PTT) insertion were also recorded and compared. Results The average incisor-glottic distance of one hundred and twenty patients was (16.7±1.1) cm [(17.1±1.1) cm for males and (16.2±1.0) cm for females], with a maximum of 20.0 cm and a minimum of 14.5 cm. The one-time success rate of trachea puncture in group U was significantly higher than that of group T(P 0.05). Conclusions Ultrasound-guided ETT withdrawal and repositioning is feasible and safe. This method can avoid the interference of ETT in PDT, increase the success rate of tracheal puncture, shorten the operation time, and improve the oxygenation during operation. Key words: Ultrasound guidance; Percutaneous dilatational tracheostomy; Endotracheal tube