Ultrasound Guided Percutaneous Tracheostomy versus Conventional Tracheostomy; Technique and Outcome

Abstract

he oldest recorded surgical procedure on the airway is in the Edwin Smith Papyrus, an ancient Egyptian medical text thought to date around 1600 BCE. It illustrates what is thought to be a tracheotomy to provide an emergency airway. With the evolution of mechanical ventilation, the indications for elective tracheostomy increased to include reduction of anatomical dead space, avoidance of laryngeal injury caused by prolonged intubation, aid in management of tracheobronchial and pulmonary secretions and to facilitate weaning off mechanical ventilation. Recently, it was found that the length of stay in the ICU and duration of mechanical ventilation was significantly lower with early tracheostomy. However, timing of tracheostomy had no effect on mortality or the development of pneumonia. Percutaneous tracheostomy has become a safe alternative to conventional surgical tracheostomy being an easier safe bedside procedure with a very low rate of complications. Many assisting tools have been suggested to guide the procedure of percutaneous tracheostomy and decrease the incidence of complications such as bleeding due to vascular injury, hypercapnia and false passage. Fiberoptic flexible bronchoscopy provides the vision required to confirm tracheostomy tube placement and prevent posterior tracheal wall lesions.