To evaluate the necessity of guidance methods such as bronchoscopy and ultrasound during percutaneous dilational tracheostomy (PDT).
Approach:
Bronchoscopy: The study by Nachshon et al. indicated that routine bronchoscopic guidance does not reduce major complications or mortality but increases procedural time and costs.
Ultrasound: Ultrasound scanning before the procedure identifies pre-tracheal vessels and enhances accuracy during PDT, improving first-pass success rates.
Off-midline puncture: The potential for increased stomal complications, particularly dehiscence, may arise from off-midline punctures, although direct evidence is lacking.
Key Findings:
Bronchoscopy may be beneficial for less experienced operators and in challenging anatomical cases.
Ultrasound-guided PDT is non-inferior to bronchoscopy-guided PDT and both methods are complementary.
The relationship between off-midline puncture and late complications like stenosis remains unexplored.
Interpretation:
The findings suggest a need for a multimodal, risk-stratified approach to PDT that includes bronchoscopy and/or ultrasound for specific patient populations.
Limitations:
The RCT by Nachshon et al. involved experienced operators, limiting generalizability.
Details regarding long-term complications and tracheostomy cannula entrance were not documented in the RCT.
Conclusion:
Multicentre RCTs are recommended to further investigate the roles of bronchoscopy and ultrasound in PDT, particularly for selected patient groups.
