Video-guided Percutaneous Tracheostomy (PCT): Evaluating the Safety, Efficacy and Simplicity of a Novel Technique, Compared to Conventional PCT

Background

Percutaneous tracheostomy (PCT) is commonly used in critically-ill patients who require long-term mechanical ventilation in the intensive care unit (ICU). While being effective and safe, this technique has some complications. These include paratracheal insertion of the tracheostomy tube, tracheal injury; puncturing the cuff and transfixing the endotracheal tube (ETT) during the transtracheal needle insertion; inserting the guide wire through Murphy's eye; or accidental extubation while withdrawing the endotracheal tube during the procedure leading to loss of the airway [1-6].

Although using the fingertip to palpate the trachea and endotracheal tube is a useful technique to locate the tip of the endotracheal tube during the procedure, it is unreliable, particularly in patients with short and thick necks. There are reports of lower rates of acute complications under endoscopic (bronchoscopic) guidance [7-11]. However, there is no adequate controlled study showing that endoscopic-guided tracheostomy is superior to the 'blind' one. Moreover, it is an expensive tool which is not readily available in some centers.

Video guidance provides a cost-effective alternative to bronchoscopes, that may also reduce the risk of procedure-related complications such as paratracheal insertion of the tracheostomy tube, tracheal injury or cuff puncture [12].

The goal of this study is to evaluate the safety, efficacy and operability of video-guided PCT compared with standard PCT. Video-guided PCT, a bedside safe and simple technique that can be performed in the ICU without the assistance of a pulmonologist, may overcome some of the limitations of the standard percutaneous tracheostomy.