Comparison of percutaneous dilational tracheotomy using bronchoscope，ultrasound guidance and anatomical landmark

Abstract

Objective To compare the efficacy and safety of percutaneous dilational tracheostomy（PDT）using fiberoptic bronchoscope，ultrasound guidance and anatomic landmark localization. Methods In this retrospective cohort，101 patients undergoing PDT were enrolled and divided into bronchoscope-guided group（n = 39），ultrasound-guided group（n = 27），and anatomical landmark localization group（n = 35）. Demographic data，general condition，surgical condition，postoperative complication and clinical prognosis were collected. Results No statistical significance was found in age，sex，cause of ICU stay，primary disease and preoperative coagulation status（all P > 0.05）. In the ultrasound-guided group，preoperative Sequential Organ Failure Assessment（SOFA）score was higher，the operation time was shorter and intraoperative blood loss was less compared with those in the other two groups（P < 0.05/3）. The PaCO2 in the anatomical landmark localization group was lower than that in the ultrasound-guided group（P < 0.05/3）. Conclusions Real-time ultrasound guidance during PDT can be employed to identify the anatomical structures of the neck，which can shorten the operation time，reduce intraoperative bleeding and avoid hyperventilation in patients with severe diseases. Ultrasound-guided PDT may serve as an alternative regimen for PDT using bronchoscope or anatomical landmark localization.

Keywords

• critical illness|percutaneous dilational tracheostomy|bronchoscope|ultrasound guidance|anatomical landmark localization