Percutaneous dilatational tracheostomy versus fibre optic bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomised controlled trial
- 77 Downloads
To determine whether fibre optic bronchoscopy-guided percutaneous dilatational tracheostomy (FOB-PDT) is a better option in critically ill patients, we compared the efficacy and incidence of procedure complications between PDT with and without FOB.
We included 90 patients with oral intubation and mechanical ventilation who received PDT with (n = 45, FOB-PDT group) and without (n = 45, PDT group) FOB. For all patients, a simplification of the Griggs technique was used in this study with a central venous catheter set and dilating forceps. Demographic data, body mass index (BMI), Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, rate of first-time success, complication rate and time of procedure were evaluated in both groups. PDT was performed guided by FOB only in the FOB-PDT group.
The rate of major complications, including minor or major haemorrhage requiring intervention and subcutaneous emphysema in the neck or pneumothorax, was significantly higher in the PDT group than in the PDT-FOB group (40% vs. 20%, P < 0.05). Significant differences were observed between the two groups with respect to the rate of first-time success (64.4% vs. 93.3%, P < 0.05); the rate of first-time success puncture with the puncture needle in the PDT-FOB group was higher than that in the PDT group (93.3% vs. 75.6%, P < 0.05). The mean procedure duration was significantly longer in the PDT group than in the PDT-FOB group (12.9 ± 1.1 vs. 9.8 ± 1.2 min, P < 0 .05).
PDT with FOB offers the advantages of a high rate of first-time success, a low complication rate and short-procedure duration. Thus, FOB-PDT is a better option in critically ill patients.
KeywordsBronchoscopy Mechanical ventilation Tracheostomy
This study is financially supported by the Natural Science Foundation of Anhui University (KJ2016A730 and KJ2016A718) and the Anhui Provincial Natural Science Foundation (1608085MH199).
G.S. and T.Y. designed the present study. Data analysis was conducted by H.Y. and Y.C. All the authors were involved in the execution of the present study. All the authors participated in preparation of the manuscript and approved its final version for publication.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Saritas A, Kurnaz MM. (2017) Comparison of bronchoscopy-guided and real-time ultrasound-guided percutaneous dilatational tracheostomy: safety, complications, and effectiveness in critically ill patients. J Intensive Care Med. https://doi.org/10.1177/0885066617705641
- 6.Grensemann J, Eichler L, Kahler S et al (2017) Bronchoscopy versus an endotracheal tube mounted camera for the peri-interventional visualization of percutaneous dilatational tracheostomy - a prospective, randomized trial (VivaPDT). Crit Care 21:330. https://doi.org/10.1186/s13054-017-1901-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Gobatto AL, Besen BA, Tierno PF et al (2016) Ultrasound-guided percutaneous dilational tracheostomy versus bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients (TRACHUS): a randomized noninferiority controlled trial. Intensive Care Med 42:342–351. https://doi.org/10.1007/s00134-016-4218-6 CrossRefPubMedGoogle Scholar
- 13.Riker RR, Shehabi Y, Bokesch PM, Ceraso D, Wisemandle W, Koura F, Whitten P, Margolis BD, Byrne DW, Ely EW, Rocha MG, SEDCOM (Safety and Efficacy of Dexmedetomidine Compared With Midazolam) Study Group (2009) Dexmedetomidine vs midazolam for sedation of critically ill patients: a randomized trial. JAMA 301:489–499. https://doi.org/10.1001/jama.2009.56 CrossRefPubMedGoogle Scholar
- 14.Kost KM (2005) Endoscopic percutaneous dilatational tracheotomy: a prospective evaluation of 500 consecutive cases. Laryngoscope 115:1–30. https://doi.org/10.1097/01.MLG.0000163744.89688.E8 CrossRefPubMedGoogle Scholar
- 15.Dinh VA, Farshidpanah S, Lu S, Stokes P, Chrissian A, Shah H, Giri P, Hecht D, Nguyen HB (2014) Real-time sonographically guided percutaneous dilatational tracheostomy using a long-axis approach compared to the landmark technique. J Ultrasound Med 33:1407–1415. https://doi.org/10.7863/ultra.33.8.1407 CrossRefPubMedGoogle Scholar
- 16.Rudas M, Seppelt I, Herkes R, Hislop R, Rajbhandari D, Weisbrodt L (2014) Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial. Crit Care 18:514. https://doi.org/10.1186/s13054-014-0514-0 CrossRefPubMedPubMedCentralGoogle Scholar