Percutaneous dilatational tracheostomy and thyroid isthmus penetration (PETRIS)

To evaluate the clinical relevance of thyroid isthmus penetration during percutaneous dilatational tracheostomy (PDTS) and to explore the role of ultrasound (US) in procedural guidance and patient selection.

Single-center, prospective interventional study.

Intensive care unit of a tertiary academic hospital.

Adult patients requiring tracheostomy due to prolonged mechanical ventilation or neurological impairment.

Following pre-procedural ultrasound assessment, patients deemed suitable for PDTS were allocated to either a landmark-based technique (Group A) or ultrasound-guided technique (Group B). Ultrasound was also used for post-puncture documentation of guidewire position. Bronchoscopic verification was performed in all cases.

Among 180 tracheostomies performed, 100 PDTS procedures were analyzed (51 Group A, 49 Group B). In 68% of cases, the tracheostomy trajectory traversed the thyroid isthmus. Early complication rates were similar between trans-isthmic and non-trans-isthmic procedures (4.4% vs. 3.1%; p = 1.00) and between Group A and Group B (2.0% vs. 6.1%; p = 0.342). Compared with surgical tracheostomy, PDTS demonstrated a lower observed complication rate (4.0% vs. 23.9%; p < 0.001), although this comparison was confounded by baseline differences. Bronchoscopic inspection prompted guidewire repositioning in 5% of cases.

Trans-isthmic PDTS is common and, within this preselected cohort, was not associated with a higher observed rate of early complications. Pre-procedural ultrasound appears valuable for anatomical assessment and patient selection, while the additional benefit of intra-procedural ultrasound guidance in reducing early complications was not demonstrated. These findings are exploratory and should be confirmed in larger studies.

The study was registered with ClinicalTrials.gov (NCT05792098; March 30, 2023).