title: Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: a retrospective cohort study.
abstract: BACKGROUND
  Percutaneous dilational tracheostomy (PDT) is routinely performed in the intensive care unit with bronchoscopic guidance. Recently, ultrasound (US) has emerged as a new safety adjunct tool to increase the efficacy of PDT. However, the available data are limited to case series without any control group. Hence, a retrospective cohort study was designed to evaluate the efficacy of US-guided PDT compared with bronchoscopy-guided PDT.
  
  
  METHODS
  All patients who were submitted to PDT after the standardization of US-guided PDT technique in our institution were analyzed. Demographic and procedure-related variables, complications, and clinical outcomes were collected and compared in patients undergoing US- or bronchoscopy-guided PDT.
  
  
  RESULTS
  Sixty patients who had been submitted to PDT were studied, including 11 under bronchoscopy guidance and 49 under US guidance. No surgical conversion was necessary in any of the procedures, and bronchoscopy assistance was only required in 1 case in the US group. The procedure length was shorter in the US group than in the bronchoscopy group (12 vs 15 minutes, P = .028). None of the patients had any major complications. The minor complication rates were not significantly different between the groups, nor was the probability of breathing without assistance within 28 days, intensive care unit length of stay, or hospital mortality.
  
  
  CONCLUSIONS
  Ultrasound-guided PDT is effective, safe, and associated with similar complication rates and clinical outcomes compared with bronchoscopy-guided PDT.
authors.affiliation: Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Surgical Intensive Care Unit, Anesthesiology Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil. Electronic address: andregobatto@gmail.com.
authors.forename: André Luiz Nunes
authors.initials: AL
authors.lastname: Gobatto
authors.affiliation: Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Bruno Adler Maccagnan Pinheiro
authors.initials: BA
authors.lastname: Besen
authors.affiliation: Trauma Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Paulo Fernando Guimarães Morando Marzocchi
authors.initials: PF
authors.lastname: Tierno
authors.affiliation: Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Pedro Vitale
authors.initials: PV
authors.lastname: Mendes
authors.affiliation: Trauma Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Filipe
authors.initials: F
authors.lastname: Cadamuro
authors.affiliation: Intensive Care Unit, Infectious Disease Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Daniel
authors.initials: D
authors.lastname: Joelsons
authors.affiliation: Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Livia
authors.initials: L
authors.lastname: Melro
authors.affiliation: Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Park
authors.affiliation: Trauma Intensive Care Unit, Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil; Surgical Intensive Care Unit, Anesthesiology Department, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
authors.forename: Luiz Marcelo Sá
authors.initials: LM
authors.lastname: Malbouisson
mesh_terms: D000328:Adult; D001999:Bronchoscopy / Q000009:adverse effects / Q000379:methods*; D016638:Critical Illness; D004106:Dilatation / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*
keywords: Bronchoscopy; Tracheostomy; Ultrasound