Skip to main content

Ultrasound scanning for percutaneous dilatational tracheostomy: a systematic review


Percutaneous dilatational tracheostomy (PDT) remains a frequently performed procedure in the ICU. However, there is great variability in the course of blood vessels in the pre-tracheal area. A 5% risk of clinically relevant bleeding was recently reported for patients undergoing PDT [1]. We conducted a systematic review of reports evaluating clinical outcomes following use of ultrasound scanning (US) for PDT.


Two investigators performed a search of the literature using the following databases: CENTRAL, Embase, MEDLINE and SCOPUS. The following eligibility criteria were used: population including adults >16 years managed in the ICU; use of ultrasound to guide decisionmaking pre-PDT or guide PDT performance; report of clinically relevant outcome measures. Nonrandomised controlled trials were classified according to Cochrane Non-Randomised Study Methods Group criteria [2] and evaluated for risk of bias.


An initial search identified 2,043 reports, of which 10 studies met eligibility criteria: eight case series, one randomised controlled trial (RCT) and one prospective cohort study, incorporating 488 patients. Two studies specifically reported data on patients with obesity (n = 29 patients) and one study reported data for a group of patients with spinal cord fixation (n = 6). US was used to guide decision to perform PDT or surgical tracheostomy in five studies, with decision to perform surgical tracheostomy ranging from 0 to 27% of cases. US was used to guide insertion point in seven studies, and used real-time in four studies. Times to perform US-guided PDT were reported in four studies (ranging from 8 to 12 minutes). No studies compared time taken with or without US. Data on complications of procedure were reported in nine studies. Minor bleeding was reported for eight cases (1.6% overall). Prolonged bleeding was reported in two cases (0.4%). There were no episodes of catastrophic bleeding among 488 cases. High risk of bias was identified in five studies in terms of patient selection. An intervention protocol was not defined in three reports. No attempt was made at blinding any aspect of the 10 studies.


Use of US guidance could theoretically help minimise risk of haemorrhagic complications during PDT and perhaps reduce time taken to perform PDT. However, there is currently inadequate evidence from controlled cohort studies or RCTs to suggest that routine use for PDT in selected or unselected groups improves clinically relevant outcome measure.


  1. 1.

    Delaney , et al.: Crit Care. 2006, 10: R55. 10.1186/cc4887

    PubMed Central  Article  PubMed  Google Scholar 

  2. 2.

    Higgins JPT, Green S:Cochrane Handbook for Systematic Reviews of Interventions. 2011. Version 5.1.0. The Cochrane Collaboration []

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to R Pugh.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Pugh, R., Slater, A. Ultrasound scanning for percutaneous dilatational tracheostomy: a systematic review. Crit Care 17, P163 (2013).

Download citation


  • Ultrasound Scanning
  • Insertion Point
  • Group Criterion
  • Minor Bleeding
  • Percutaneous Dilatational Tracheostomy