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Korean J Anesthesiol > Epub ahead of print
DOI: https://doi.org/10.4097/kja.d.18.00276    [Epub ahead of print]
Published online February 12, 2019.
Identifying the ideal tracheostomy site based on patient characteristics during percutaneous dilatational tracheostomy without bronchoscopy
Jiho Park1, Woosuk Chung1,2, Seunghyun Song1, Yoon-Hee Kim1,2, ChaeSeong Lim1,2, Youngkwon Ko1,2, Sangwon Yun1, Hyunwoo Park1, Sangil Park1, Boohwi Hong1,2
1Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital
2Department of Anesthesiology and Pain Medicine, College of Medicine, Chungnam National University
Corresponding author:  Boohwi Hong, Tel: 82-42-280-7840, Fax: 82-42-280-7968, 
Email: koho0127@gmail.com
Received: 19 September 2018   • Revised: 28 January 2019   • Accepted: 11 February 2019
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 of 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 3-dimensional neck computed tomography (CT) 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.
Key Words: Tracheostomy; Airway management; Critical Care; Regression Analysis; Cricoid cartilage; Trachea
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