Ultrasound Guided Percutaneous Tracheostomy versus Conventional Tracheostomy: Technique and Outcome

Abstract

Abstract Background: In the 21st century, the majority of trache-ostomies are now inserted by the intensivists in the intensive care unit (ICU). It is one of the most frequent procedures performed in critically ill patients. It has been advocated for those requiring prolonged mechanical ventilation because it facilitates weaning by decreasing the work of breathing, decreases the requirement for sedation and may allow for earlier patient mobilization, feeding and physical and occu-pational therapy. Aim of Study: To evaluate ultrasound guided percutaneous tracheostomy and conventional tracheostomy in critically ill patients regarding effect on outcome (weaning from mechanical ventilation and ICU stay), duration of the technique, success rate and to evaluate incidence of perioperative, early and late complications. Patients and Methods: Our study is a randomized con-trolled clinical trial conducted on 40 critically ill patients admitted to the Intensive Care Unit at Ain Shams University Hospitals, from the period from September 2020 until March 2021 they were intubated and mechanically ventilated and required elective percutaneous dilatational tracheotomy. Results: US-guided group showed fewer procedural com-plications compared to conventional group. We had faced procedural complications in conventional group in form of 2 (10%) of patients suffer from hypoxemia, Pneumothorax, decannulation and post. Tracheal wall injury. 3 (15%) of patients had transient hypotension and false passage. And 5 (25%) cases of perforation of ETT cuff during insertion, one case (5%) of subcutaneous emphysema and 7 (35%) cases of minor bleeding compered to three cases of minor bleeding in US-guided group, one case of decannulation and three case of transient hypotension. No early complications were detected in both study groups; except one case of tube obstruction or displacement in conventional group. According to late com-plications our analysis illustrates decrease in late complication in US-guided group 2 (10%) versus 4 (20%) in conventional group. In US-guided group only two cases of Stoma site infection resolved by antibiotic and local care. In conventional group there were two case of Tracheoesophageal fistula, one case of Stoma site infection and one case of Tracheoinnominate fistula. Conclusion: Percutaneous dilatational tracheostomy could be a safer procedure when performed by using peri- and preoperative US assistance. The use of US guidance for percutaneous dilatational tracheostomy could reduce the complication rates of the procedure. The ultrasound-guided percutaneous dilatational tracheostomy seems to reduce the late and early complications when compared to the anatomical landmark guided Percutaneous dilatational tracheostomy. Pre-procedural US-guided percutaneous dilatational tracheostomy can be considered as a reliable tool to increase safety and improve outcomes of elective tracheostomy.