Comparison Between Real-Time Ultrasound-Guided Percutaneous Tracheostomy and Surgical Tracheostomy in Critically Ill Patients

Abstract

Background. Ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) has been adapted for use in intensive care units (ICU). US-PDT is comparable to bronchoscopy-assisted tracheostomy. However, compared to surgical tracheostomy (ST), its safety and effectiveness have not been well studied. Objectives. To determine the efficacy and safety of US-PDT compared to ST. Materials and Methods. A total of 90 patients who underwent US-PDT (n = 36) or ST (n = 54) between July 2019 and September 2020 were enrolled. US-PDT was performed in the ICU without a surgical assistant or bronchoscope. Data were collected retrospectively and analyzed regarding clinical characteristics, procedure times and details, complications, and mortality rate. Results. The success rate of US-PDT was 97.4% and the procedure time was shorter than ST (5.2 ± 3.1 vs. 10.5 ± 5.0 min). There were no significant differences in clinical characteristics and procedure details. There was no procedure-related mortality in either of the groups. Conclusions. US-PDT is time-efficient and as safe as ST. Based on our results, US-PDT may be considered a potential alternative to ST in high-risk patients and in those who cannot be transported.

Comparison of percutaneous single-stage dilatational tracheostomy and surgical tracheostomy in critically ill patients: A randomized controlled trial

“…also found that PDT had significantly shorter procedure time than ST (5.2 ± 3.1 vs. 10.5 ± 5.0 min, P < 0.05). [ 3 ] Gupta et al . also reported that the duration of the procedure was significantly lesser in the PDT group than ST group (19.1 ± 11.7 vs. 28.3 ± 18.4 min, P = 0.0001).…”

“…The primary benefit of PDT is that it may be carried out at the patient’s bedside in an ICU, reducing surgery, and personnel expenses as well as minimizing the risks associated with transport. [ 2 3 4 ]…”

Tracheostomy: Review of Literature

“…However, some authors note that PDT using a bronchoscope has limitations due to the difficulty of accurately identifying the anatomical structures of the neck and preventing complications such as vascular damage 26,27 . Several studies suggest that ultrasound-guided PDT has potential benefits, including portability, safety, identification of cervical vascularity and localization of the tracheal puncture site, reduced procedure time and complications [26][27][28][29][30] . Kang HT et al (2022) concluded in their study that ultrasound-assisted PDT could be offered as an alternative to surgical tracheostomy in high-risk patients 30 .…”

“…Several studies suggest that ultrasound-guided PDT has potential benefits, including portability, safety, identification of cervical vascularity and localization of the tracheal puncture site, reduced procedure time and complications [26][27][28][29][30] . Kang HT et al (2022) concluded in their study that ultrasound-assisted PDT could be offered as an alternative to surgical tracheostomy in high-risk patients 30 . Protocols proposed in May 2020 for the management of Covid-19 infected patients in the ICU recommend OT as less safe in terms of aerosol spread of the virus compared to PDT, and therefore reduces the potential risk of transmitting a viral infection to medical staff 31 .…”

Comparison of Outcomes in Critically Ill Patients Installed with Mechanical Ventilation Performed Early and Late Tracheostomy at Dr. M. Djamil General Hospital Padang

“…2 From these studies, it was found that earlier tracheostomy placement can provide benefits in patients who require prolonged mechanical ventilation. [3][4][5] Several factors are known to influence the outcome in patients undergoing tracheostomy. Another study said that age and comorbidities affect the mortality rate in patients who underwent tracheostomy.…”