SAP Rehabilitation and Sports Medicine
SAP Rehabilitation and Sports Medicine
Case Report 2026 Vol. 6 rsm2026211

Ultrasound-guided, videolaryngoscopy-assisted percutaneous tracheostomy in a high-altitude patient. Case report

Adrian Avila-Hilari1 , Jhossmar Cristians Auza-Santivañez2 , Nehemias Teddy Ayca Morales3 , Reynan Burgoa Apaza1 , Freddy Ednildon Bautista-Vanegas4 , Jorge Márquez Molina5 , Edwin Cruz Choquetopa6 , Osman Arteaga Iriarte7
1Clínica CIES. Unidad de Cuidados Intensivos. La Paz, Bolivia.
2Hospital del Gran Chaco Fray Quebracho de III nivel. Unidad de Cuidados Intensivos.Tarija, Bolivia.
3Hospital de Clínicas. Unidad de Cuidados Intensivos. La Paz, Bolivia.
4Neorokliniken Beelitz GmbH Neurologische Rehabilitationsklinik: Beelitz Heilstätten, Brandenburg, DE. Germany.
5Hospital del Norte. Departamento de emergencias. Cochabamba, Bolivia.
6Hospital del Sud. Unidad de Cuidados Intensivos. Cochabamba, Bolivia.
7Hospital Universitario Japonés. Unidad de Cuidados intensivos. Santa Cruz, Bolivia.

https://doi.org/10.62486/rsm2026211

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Abstract

Introduction: Percutaneous dilation tracheostomy has largely replaced surgical tracheostomy in most intensive care units. Bronchoscopy remains the standard guidance method, although it partially obstructs the tube lumen, increases carbon dioxide levels, and requires equipment that is not always available. At high altitudes, where arterial oxygen levels are already reduced, these disadvantages are even more significant. Case report: An 82-year-old male patient, a permanent resident at 3650 meters above sea level, was admitted to the intensive care unit for a right hemisphere ischemic stroke, hemodynamic and ventilatory instability, atrial flutter, bilateral pleural effusion, and hospital-acquired pneumonia. After 16 days of invasive ventilation, a bedside tracheostomy was planned. A 5-10 MHz linear transducer identified the thyroid and cricoid cartilages, the tracheal rings, the pretracheal tissue, and the absence of vessels along the planned tracheostomy path. The videolaryngoscope allowed for the withdrawal of the endotracheal tube under direct vision until the cuff was positioned immediately below the vocal cords. The cannula was inserted using a modified Seldinger technique, with oxygenation goals appropriate for high altitude. Discussion: Ultrasound and videolaryngoscopy address different problems: the former defines the extraluminal anatomy of the anterior neck, while the latter monitors the endolaryngeal position of the tube and its cuff. Their combination reproduces much of the information provided by bronchoscopy without inserting an instrument into the tube lumen, a significant advantage in a patient whose baseline arterial oxygen pressure is approximately 56 mmHg. Conclusions: Ultrasound-guided, videolaryngoscopy-assisted percutaneous tracheostomy by dilation proved feasible at the bedside of a neurocritically ill patient residing at 3650 meters above sea level, without immediate complications and respecting the oxygenation goals specific to high altitude.

Keywords

Percutaneous tracheostomy, POCUS, videolaryngoscopy, high altitude, intensive care, bronchoscopy

CONCLUSIONES

La traqueostomía percutánea por dilatación guiada por ecografía y asistida por videolaringoscopia resultó factible a la cabecera de un paciente neurocrítico residente a 3650 msnm, sin complicaciones inmediatas y respetando las metas de oxigenación propias de la gran altitud. La utilidad de la combinación proviene de la complementariedad entre ambas herramientas, la ecografía define la anatomía que la palpación no discrimina y el videolaringoscopio vigila el momento en que el tubo endotraqueal deja de estar protegido. Frente a la broncoscopia, la diferencia práctica más relevante no es la calidad de la imagen sino la conservación de la luz del tubo, condición que adquiere otro significado cuando la presión arterial de oxígeno basal del paciente se sitúa cerca de 56 mmHg. La relevancia del caso clínico justifica que las UCI situadas en la altitud, con acceso irregular a broncoscopia flexible, consideren esta estrategia dentro de un protocolo con registro sistemático de variables gasométricas y de complicaciones, único camino para convertir una observación aislada en evidencia utilizable.

Figura 1. TAC de cráneo A: se observa imágenes hipodensas en el hemisferio derecho. B: TAC de tórax se observa imágenes hipodensas en proyección de ambas bases pulmonares.
Figura 2. Ecografía cervical. A: insonación longitudinal del cuello. B: identificación del tubo endotraqueal y su manguito, cartílago cricoides y anillos traqueales.
Figura 3. A: Se observa realización de Videolaringoscopia. B: Valoración de las cuerdas vocales previa a la movilización del tubo endotraqueal. C: Manguito visualizado por debajo del plano glótico, en posición adecuada.

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Declaraciones

Financiación

Los autores no recibieron financiación para el desarrollo de la presente investigación.

Conflictos de interés

Los autores declaran que no existe conflicto de intereses.

Contribución de autoría

Conceptualización: Adrian Avila-Hilari

Curación de datos: Reynan Burgoa Apaza.

Análisis formal: Nehemias Teddy Ayca Morales.

Investigación: Jhossmar Cristians Auza-Santivañez.

Metodología: Jhossmar Cristians Auza-Santivañez, Adrian Avila-Hilari.

Administración del proyecto: Adrian Avila-Hilari.

Recursos: Adrian Avila-Hilari.

Software: Edwin Cruz Choquetopa.

Supervisión: Freddy Ednildon Bautista-Vanegas.

Validación: Adrian Avila-Hilari

Visualización: Freddy Ednildon Bautista-Vanegas

Redacción – borrador original: Adrian Avila-Hilari, Jhossmar Cristians Auza-Santivañez, Nehemias Teddy Ayca Morales, Reynan Burgoa Apaza, Freddy Ednildon Bautista-Vanegas, Jorge Márquez Molina, Edwin Cruz Choquetopa, Osman Arteaga Iriarte.

Redacción – revisión y edición: Adrian Avila-Hilari, Jhossmar Cristians Auza-Santivañez, Nehemias Teddy Ayca Morales, Reynan Burgoa Apaza, Freddy Ednildon Bautista-Vanegas, Jorge Márquez Molina, Edwin Cruz Choquetopa, Osman Arteaga Iriarte.

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