Abstract
Introduction: We aimed to compare the procedural time, efficacy, and incidence of complications of ultrasonography and fiberoptic bronchoscope-guided percutaneous dilatational tracheostomy (PDT). Methods: The study population included the patients admitted to the department of anesthesiology and critical care. In this prospective observational study, we randomly divided 60 participants into two groups. In the ultrasound (US)-guided group, ultrasonography was used for PDT. While in the FOB guided group, we used the fiberoptic bronchoscope (FOB). We compared efficacy parameters and complications between the two groups. The mean values were compared between study groups using an independent sample t-test. Categorical outcomes were compared using the chi-square test. P-value < 0.05 was considered statistically significant. Results: Compared with the bronchoscopy group, the US group had a significantly shorter PDT operation time (11.8 ± 2.5 versus 15.43 ± 3.27 mins, P < 0.001). FOB group had fewer puncture attempts than the US group. FOB group had more central punctures than the US group (p < 0.001). Among PDT complications, bleeding happened in two patients (6.67%) in the FOB group and tracheal tube cuff puncture was observed in 8 (26.67%) patients in the US group. Conclusion: The US-guided PDT consumes less time for the procedure compared to bronchoscope-guided PDT. FOB was more effective in terms of parameters like the number of needle puncture attempts, the accuracy of the puncture site, the incidence of the posterior tracheal wall hit compared to US-guided PDT. Complications like bleeding were present in FOB.
Highlights
Tracheostomy maintains temporarily or permanently tracheal patency, and it is performed through an incision over the trachea, followed by the insertion of a tracheostomy tube
Bronchoscopy guidance has been traditionally used as an adjunct to Percutaneous dilatational tracheostomy (PDT) for safety purposes, as it helps in the appropriate selection of the tracheal puncture site and guides the real-time needle penetration into the trachea, thereby reducing the chance for posterior wall lesions[4,5]
A total of 60 patients were included in the final analysis; 30 (50%) patients went with the ultrasound-guided, and the remaining 30 (50%) participants went with fiberoptic bronchoscopy
Summary
Tracheostomy maintains temporarily or permanently tracheal patency, and it is performed through an incision over the trachea, followed by the insertion of a tracheostomy tube. Percutaneous dilatational tracheostomy (PDT) is routinely performed in the intensive care unit for critically ill patients. In PDT, blunt dissection of pre-tracheal tissues is done, followed by dilatation of trachea over the guidewire and insertion of tracheal cannula using the Seldinger technique[2,3]. Bronchoscopy guidance has been traditionally used as an adjunct to PDT for safety purposes, as it helps in the appropriate selection of the tracheal puncture site and guides the real-time needle penetration into the trachea, thereby reducing the chance for posterior wall lesions[4,5]. A higher incidence of complications in obese patients has been reported, as it is difficult to identify anatomical landmarks on physical examination in such cases[6,7]
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