Clin Exp Otorhinolaryngol.  2023 Nov;16(4):388-394. 10.21053/ceo.2023.01088.

Comparison between Real-Time Ultrasound-guided Percutaneous Dilatational Tracheostomy and Surgical Tracheostomy in critically ill Patients: A Randomized Controlled Trial

• Kim SY
• Lee SW
• Baek A
• Park KN

• KMID: 2548367
• DOI: http://doi.org/10.21053/ceo.2023.01088

Abstract

Objectives
Tracheostomy is an important procedure for critically ill patients in the intensive care unit (ICU), and percutaneous dilatational tracheostomy (PDT) has gained popularity due to its safety and effectiveness. However, there are limited data comparing ultrasound-guided PDT (US-PDT) with surgical tracheostomy (ST). In our previous study, we reported that US-PDT had similar safety and effectiveness to ST, with a shorter procedure time. However, the study design was retrospective, and the sample size was small. Therefore, we conducted a randomized controlled trial to demonstrate the safety and efficacy of US-PDT compared to ST.
Methods
A total of 70 patients who underwent either US-PDT (n=35) or ST (n=35) were enrolled in the study between October 20, 2020, and July 26, 2022. The patients were randomly assigned to their respective procedures. The data collected included patient clinical characteristics, procedure time and details, complications, duration of ICU stay, time taken for weaning from mechanical ventilation, and hospital mortality.
Results
The procedure time of US-PDT was shorter than that of ST (4.0±2.2 minutes vs. 10.1±4.6 minutes). The incision length of US-PDT was also shorter than that of ST (1.5±0.5 cm vs. 1.8±0.4 cm). There were no statistically significant differences in demographics, procedure details, complications, length of ICU stay, ventilator weaning time, and hospital mortality.
Conclusion
US-PDT has a similar complication rate and shorter procedure time compared with ST. It can be safely and effectively performed in critically ill patients and can serve as a potential alternative to ST.

Keyword

Tracheostomy; Ultrasonography; Intensive Care Units; Percutaneous Tracheostomy

Figure

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  Fig. 1. (A, B) Following the real-time ultrasound-guided repositioning of the endotracheal tube, the tip of the E-tube is observed to push the tracheal wall anteriorly at the level of the second tracheal ring. (C, D) A guide needle is inserted into the midline of the trachea under ultrasound guidance. Correct needle positioning within the tracheal lumen is confirmed by observing the regurgitation of air into a saline-filled syringe. C, cricoid cartilage; T2, second tracheal ring.

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  Fig. 2. Flowchart of patient enrollment. ST, surgical tracheostomy; US-PDT, ultrasound-guided percutaneous dilatational tracheostomy.

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