Comparison of 3 techniques in percutaneous tracheostomy: Traditional landmark technique; ultrasonography-guided long-axis approach; and short-axis approach – Randomised controlled study

Introduction: The aim of this study is to compare the reliabilities of the traditional landmark method, ultrasonography-guided long-axis in-plane application, and ultrasonography-guided short-axis out-of-plane application in percutaneous dilatational tracheostomy. Patients and methods: A total of 60 patients were divided in 3 random groups undergoing percutaneous tracheostomy by using landmark method, ultrasonography-guided out-of-plane method, and ultrasonography-guided in-plane method. While demographic data of the patients were recorded before the procedure, number of punctures, success rate at the first entry, rate of successful tracheostomy tube placement, total tracheostomy time, and complications were recorded during and after the procedure. Results and discussion: It was found that 23 women and 37 men were included in the study, the average age of the cases was 68.0 ± 15.5; mean body mass index was 27.9 ± 4.3; mean APACHE II scores were 27.4 ± 4.6 and there was no significant difference between the groups in terms of demographic data. The ultrasonography-guided out-of-plane application had significantly lower number of punctures, higher first entry success, and fewer complications compared to the other groups. Independently from the groups, first entry success was significantly low in advanced age and number of punctures significantly increased the complication rate. Conclusion: In this randomised controlled study, it was found that ultrasonography-guided out-of-plane application had lower number of punctures, higher first entry success rate, and less complications. It was observed that advanced age negatively affected the first entry success and as number of punctures increased, the complication rate increased. ClinicalTrials.gov ID: NCT02855749. © 2017 Société française d'anesthésie et de réanimation (Sfar)