Indian Journal of Anaesthesia (Jan 2022)

Comparison of percutaneous tracheostomy methods in ICU patients: Conventional anatomical landmark method versus ultrasonography method - A randomised controlled trial

  • Pankaj Kumar,
  • Sanjeev Kumar,
  • Mumtaz Hussain,
  • Ritu Singh,
  • Waquas Ahmed,
  • Ravi Anand

DOI
https://doi.org/10.4103/ija.ija_41_22
Journal volume & issue
Vol. 66, no. 16
pp. 207 – 212

Abstract

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Background and Aiims: Percutaneous dilational tracheostomy (PDT) is a common procedure in intensive care unit (ICU) patients requiring long-term mechanical ventilation. PDT has gradually replaced surgical tracheostomy because it is associated with minimal invasiveness, reduced bleeding and simplicity in technique.This study was conducted to compare ultrasound-guided PDT versus conventional tracheostomy in terms of duration of the procedure, number of passes and immediate peri-procedural complications. Methods: A total of 72 patients with clinical indications of tracheostomy were recruited. A total of 12 patients met the exclusion criteria. The remaining were randomly assigned into two groups of 30 each: Group A (Landmark) with traditional anatomical landmark and Group B (USG) with real-time ultrasound guidance. Puncture positions were recorded with bronchoscopy. Midline deviation was captured on a bronchoscopy image using a protractor. Data on procedural safety and efficacy were also collected. Results: Group B had significantly fewer cases of midline deviation (11.33 ± 9.51) in comparison to Group A (16.60 ± 12.31). Trials > 2 were equal to 11 in Group A and 2 in Group B. However, the duration of the procedure was higher in Group B (20.07 ± 3.25 min) as compared to Group A (15.20 ± 3.71 min). Peri-procedural and post-procedural complications were also higher in the Landmark group. Conclusion: Ultrasound-guided PDT showed superiority over landmark PDT in terms of less number of trials, midline puncture and fewer complications. However, it took a little longer to perform USG-guided PDT.

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