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. 2023 Oct-Dec;35(4):402-410.
doi: 10.5935/2965-2774.20230174-en.

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

[Article in English, Portuguese]
Pedro Fortes Osório Bustamante  1 , Bruno Adler Maccagnan Pinheiro Besen  1 , Amanda Pinto Botêga  1 , Filipe Matheus Cadamuro  1 , Marcelo Park  1 , Pedro Vitale Mendes  1 , Roberta Muriel Longo Roepke  1
Affiliations

Intensivist-led ultrasound-guided percutaneous tracheostomy: a phase IV cohort study

[Article in English, Portuguese]
Pedro Fortes Osório Bustamante et al. Crit Care Sci. 2023 Oct-Dec.

Abstract

Objective: To describe, with a larger number of patients in a real-world scenario following routine implementation, intensivist-led ultrasound-guided percutaneous dilational tracheostomy and the possible risks and complications of the procedure not identified in clinical trials.

Methods: This was a phase IV cohort study of patients admitted to three intensive care units of a quaternary academic hospital who underwent intensivist-led ultrasound-guided percutaneous tracheostomy in Brazil from September 2017 to December 2021.

Results: There were 4,810 intensive care unit admissions during the study period; 2,084 patients received mechanical ventilation, and 287 underwent tracheostomy, 227 of which were performed at bedside by the intensive care team. The main reason for intensive care unit admission was trauma, and for perform a tracheostomy it was a neurological impairment or an inability to protect the airways. The median time from intubation to tracheostomy was 14 days. Intensive care residents performed 76% of the procedures. At least one complication occurred in 29.5% of the procedures, the most common being hemodynamic instability and extubation during the procedure, with only 3 serious complications. The intensive care unit mortality was 29.1%, and the hospital mortality was 43.6%.

Conclusion: Intensivist-led ultrasound-guided percutaneous tracheostomy is feasible out of a clinical trial context with outcomes and complications comparable to those in the literature. Intensivists can acquire this competence during their training but should be aware of potential complications to enhance procedural safety.

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Figures

Figure 1
Figure 1
Flow of patients in the study.
Figure 2
Figure 2
Histogram of days from first orotracheal intubation to tracheostomy.
Figure 3
Figure 3
Time course to outcome after tracheostomy.
See this image and copyright information in PMC

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