Fiberoptic Bronchoscopy Monitoring During Percutaneous Dilatational Tracheostomy: A Multicenter, Randomized,...

Area of Science:

• Critical Care Medicine
• Surgical Procedures
• Respiratory Therapy

Background:

• Percutaneous dilatational tracheostomy (PDT) is a common procedure for prolonged mechanical ventilation.
• Endoscopic guidance is often used to improve safety and efficacy during PDT.
• The comparative benefit of routine endoscopic guidance in PDT remains under investigation.

Purpose of the Study:

• To compare the prevalence of perioperative complications between endoscopic-guided and nonendoscopic-guided PDT.
• To evaluate secondary outcomes including airway pressures, gas exchange, and mortality.

Main Methods:

• A multicenter, randomized trial involving 442 adult patients undergoing PDT in Spanish ICUs.
• Patients were randomized to either endoscopic-guided or nonendoscopic-guided PDT using the single dilatation method.
• Intention-to-treat analysis was performed.

Main Results:

• No significant difference in perioperative complication rates was observed (11.3% vs. 13.1%, p = 0.663).
• Endoscopic-guided PDT was associated with higher peak inspiratory pressures (p < 0.001) and higher Paco2 (p = 0.001).
• All-cause mortality at hospital discharge was a secondary endpoint.

Conclusions:

• Routine endoscopic guidance for PDT in critically ill patients does not reduce perioperative complication rates.
• Non-endoscopic guidance is a viable alternative for PDT when performed by experienced clinicians.
• Further research may explore specific patient subgroups where endoscopic guidance could offer benefits.