Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Apr 25;25(1):197.
doi: 10.1186/s12890-025-03645-6.

Real-time ultrasound-guided laryngeal mask assisted percutaneous dilatational tracheostomy versus bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomized controlled trial

Sameh Taha  1 , Jihad Mallat  2   3 , Mohamed Elsaidi  1 , Ashraf Al-Agami  1 , Ahmed Taha  4   5
Affiliations
Randomized Controlled Trial

Real-time ultrasound-guided laryngeal mask assisted percutaneous dilatational tracheostomy versus bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomized controlled trial

Sameh Taha et al. BMC Pulm Med. .

Abstract

Background: Percutaneous dilatational tracheostomy (PDT) is a common procedure for mechanically ventilated patients in the intensive care unit (ICU). This study compared the real-time ultrasound-guided PDT using a laryngeal mask airway (LMA) with the standard bronchoscopy-guided PDT technique in ICU patients requiring elective tracheostomy.

Methods: This randomized controlled study was conducted at Ain Shams University Hospital's Critical Care Department from December 4th, 2021, to December 3rd, 2022. The study population included 60 critically ill patients admitted to the ICU. Thirty patients were randomly assigned to the real-time ultrasound-guided LMA-assisted group, and 30 patients were randomly assigned to the bronchoscopy-guided technique. The primary study outcome was the procedure time, and the secondary outcomes included procedure-related complications rate and cost-effectiveness.

Results: The real-time ultrasound-guided LMA-assisted group had significantly shorter procedure time (median 17 [IQR: 15-20] min vs. 35 [IQR: 28-39] min, p < 0.001) and lower equipment damage (0% vs. 20%, p = 0.024) during the procedure compared to the bronchoscopy-guided group. Additionally, the cost of tracheostomy was significantly lower in the real-time ultrasound-guided LMA-assisted group (median: 300 vs. 800 USD, p < 0.001). The real-time ultrasound-guided LMA group had a lower major complications rate than the bronchoscopy-guided group (36.7%) vs. 3.3%, p = 0.002).

Conclusions: The study demonstrated that real-time ultrasound-guided LMA-assisted PDT had shorter procedure time, reduced equipment damage, lower costs, and was associated with lower complications when compared to the bronchoscopy-guided technique. These findings suggest that ultrasound guidance can enhance the efficiency and cost-effectiveness of PDT procedures.

Keywords: Bleeding; Bronchoscopy-guided tracheostomy; Complications; Critically ill patients; Intensive care unit; Laryngeal mask airway; Percutaneous dilutional tracheostomy; Ultrasound-guided tracheostomy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: The work was approved by the local Research Ethics Committee of Ain Shams University Faculty of Medicine (reference number: FMASU MD 164/2021) approved the protocol on December 3rd, 2021. The study was retrospectively registered in the ISRCTN registry (registration number ISRCTN14218985) on 02/07/2024. Informed consent: Informed written consent was obtained from the patients or their legal guardians in a private setting, where the study protocol was thoroughly explained to them. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A: Ultrasound longitudinal view of the neck showing the cricoid cartilage and the tracheal rings. B: Ultrasound cross-section of the neck showing the thyroid isthmus, tracheal cartilage, and the tracheal lumen. C: Bronchoscopy view of the inner lumen of the trachea showing the green guide wire coming from the 12 O’clock position and directed caudally. The arrow points to the best site for needle insertion between the second and third tracheal rings. The dotted line measures the distance from the skin to the tracheal cartilage. C, cricoid cartilage; I, first tracheal ring; II, second tracheal ring; III, third tracheal ring; Th, thyroid gland; IC, internal carotid
Fig. 2
Fig. 2
Study flowchart
See this image and copyright information in PMC

References

    1. Wunsch H, et al. The epidemiology of mechanical ventilation use in the united States. Crit Care Med. 2010;38:1947–53. - PubMed
    1. Goligher E, Ferguson ND. Mechanical ventilation: epidemiological insights into current practices. Curr Opin Crit Care. 2009;15:44–51. - PubMed
    1. Metnitz PG, et al. Epidemiology of mechanical ventilation: analysis of the SAPS 3 database. Intensive Care Med. 2009;35:816–25. - PubMed
    1. Hsu CL, et al. Timing of tracheostomy as a determinant of weaning success in critically ill patients: a retrospective study. Crit Care. 2005;9:R46–52. - PMC - PubMed
    1. Heffner JE. The role of tracheotomy in weaning. Chest. 2001;120:s477–81. - PubMed

Publication types

LinkOut - more resources