title: Advantages of US in percutaneous dilatational tracheostomy: randomized controlled trial and review of the literature.
abstract: OBJECTIVE
  To compare procedure times and complication rates of preincisional ultrasonographic (US) evaluation and perioperative US guidance in percutaneous dilatational tracheostomy ( PDT percutaneous dilatational tracheostomy ) with those of the current standard of care, PDT percutaneous dilatational tracheostomy performed without image guidance.
  
  
  METHODS
  Between December 2007 and January 2011, 341 patients were included in this institutional review board-approved study after informed consent was obtained from the patients or their relatives. The patients were divided randomly into two groups. In group A (n = 166), the possible causes of complications, such as aberrations of tracheal, thyroidal, and vascular structures, were determined with US, and tracheal measurements were performed by using US. The clinician's initial considerations at physical examination were compared with the US findings. PDT percutaneous dilatational tracheostomy was subsequently performed with US guidance in suitable cases. In group B (n = 175), PDT percutaneous dilatational tracheostomy was performed solely on the basis of physical landmarks. The procedure times and complication rates were compared across groups by using the Fisher exact test.
  
  
  RESULTS
  In group A, the puncture sites designated at the physical examination were reconsidered in 39 (23.8%) of 164 cases. The perioperative complication rates were slightly lower in group A (7.8% [12 of 154]) than in group B (15.0% [25 of 167]); however, the difference did not achieve statistical significance (P = .054). The mean procedure times for groups A and B were 24.09 minutes ± 8.05 (standard deviation) (range, 14-68 minutes) and 18.62 minutes ± 6.34 (range, 12-81 minutes), respectively (P = .001), and the numbers of patients in each group who required multiple puncture attempts were six (3.9%) of 154 and 23 (13.6%) of 169 (P = .003), respectively.
  
  
  CONCLUSIONS
  The use of US guidance before and during PDT percutaneous dilatational tracheostomy could render the procedure easier and safer, with fewer complications but a slightly longer procedure time.
authors.affiliation: From the Department of Radiology, Yuzuncu Yil University Hospital, School of Medical Science, Keve Kampüs, 65100 Van, Turkey (A.Y.); Department of Anesthesiology, Medstar Hospital, Antalya, Turkey (M.Y.); Department of Radiology, Dicle University School of Medical Science, Diyarbakır, Turkey (C.G.); and Department of Radiology, Akdeniz University Hospital, School of Medical Science, Antalya, Turkey (E.A., A.K.).
authors.forename: Alpaslan
authors.initials: A
authors.lastname: Yavuz
authors.forename: Murat
authors.initials: M
authors.lastname: Yılmaz
authors.forename: Cemil
authors.initials: C
authors.lastname: Göya
authors.forename: Emel
authors.initials: E
authors.lastname: Alimoglu
authors.forename: Adnan
authors.initials: A
authors.lastname: Kabaalioglu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004106:Dilatation; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D014139:Tracheostomy / Q000379:methods*; D018084:Ultrasonography, Interventional