Korean J Anesthesiol.  2019 Jun;72(3):233-237. 10.4097/kja.d.18.00276.

Identifying the ideal tracheostomy site based on patient characteristics during percutaneous dilatational tracheostomy without bronchoscopy

• Park J
• Chung W
• Song S
• Kim YH
• Lim CS
• Ko Y
• Yun S
• Park H
• Park S
• Hong B

• KMID: 2454881
• DOI: http://doi.org/10.4097/kja.d.18.00276

Abstract

BACKGROUND
We previously reported that percutaneous dilatational tracheostomy (PDT) can be safely performed 2 cm below the cricothyroid membrane without the aid of a bronchoscope. Although our simplified method is convenient and does not require sophisticated equipment, the precise location for tracheostomy cannot be confirmed. Because it is recommended that tracheostomy be performed at the second tracheal ring, we assessed whether patient characteristics could predict the distance between the cricothyroid membrane and the second tracheal ring.
METHODS
Data from 490 patients who underwent three-dimensional neck computed tomography from January 2012 to December 2015 were analyzed, and the linear distance from the upper part of the cricoid cartilage (CC) to the lower part of the second tracheal ring (2TR) was measured in the sagittal plane.
RESULTS
The mean CC-to-2TR distance was 25.26 mm (95% CI 25.02-25.48 mm). Linear regression analysis showed that the predicted CC-to-2TR distance could be calculated as −5.73 + 0.2 × height (cm) + 1.22 × sex (male: 1, female: 0) + 0.01 × age (yr) −0.03 × weight (kg) (adj. R² = 0.55).
CONCLUSIONS
These results suggest that height and sex should be considered when performing PDT without bronchoscope guidance.

Keyword

Airway management; Cricoid cartilage; Critical care; Regression analysis; Trachea; Tracheostomy

MeSH Terms

Airway Management
Bronchoscopes
Bronchoscopy*
Cricoid Cartilage
Critical Care
Female
Humans
Linear Models
Membranes
Methods
Neck
Regression Analysis
Trachea
Tracheostomy*