Is Guidance Necessary for Percutaneous Dilational Tracheostomy? Evaluating the Role of Bronchoscopy, Ultrasound, or No Assistance

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Routine bronchoscopic guidance during percutaneous dilational tracheostomy does not reduce major complications or mortality but increases procedural time and costs.
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The generalizability of the RCT results is limited due to the involvement of experienced operators, which may not reflect outcomes in less experienced hands.
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Ultrasound guidance enhances accuracy in percutaneous dilational tracheostomy, improving first-pass success rates compared to traditional techniques.
4

Off-midline puncture during tracheostomy may increase the risk of stomal complications, but definitive evidence linking it to late stenosis is lacking.
5

A multimodal, risk-stratified approach incorporating bronchoscopy and/or ultrasound is recommended for selected patients and less experienced operators.

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