Pre-procedural ultrasound assessment as a step towards the safety of percutaneous dilatational tracheostomy: a comparative study

Abstract

Background: Percutaneous dilatational tracheostomy (PDT) is an inevitable procedure indicated for mechanically ventilated critically ill patients. Ultrasound (US) assisted PDT has emerged increasing safety issues. Case series were reported to confirm the advantages of USPDT. Aim: The present study aimed to compare patients subjected to USPDT with those subjected to bronchoscope guided PDT only, regarding the easiness of technique, efficacy and safety. Materials and Methods: A prospective, randomized, comparative clinical study carried on 49 adults mechanically ventilated critically ill patients in need to maintain a secure airway through elective PDT, using Ciaglia’s Blue Rhino percutaneous dilatational tracheostomy technique. 5 patients were excluded for surgical conversion, and the remaining 44 were randomly divided into 2 groups; PDT group: patients subjected to fiber optic guided PDT, and USPDT group: patients underwent pre-procedural US imaging followed by fiber optic guided PDT. Time of the technique, procedure failure, procedure difficulty, and complications were documented, our follow up ends 24-hours after the technique. Results: Pre-procedural US guided PDT was found to be easier (P<0.05), 1 puncture was needed in the USPDT group (P<0.05) with shorter time (P<0.001). The puncture site was changed in 31.8% of the PDT group of patients but not in the USPDT group. The pre-procedural US group showed less bleeding, transient hypoxemia (P<0.05) and total number of patients with minor complications (P<0.05). Conclusion: Pre-procedural ultrasound assessment of trachea and Para-tracheal soft tissues can be considered as a reliable tool to increase safety and improve outcomes of percutaneous tracheostomy