title: Learning curve for real-time ultrasound-guided percutaneous tracheostomy.
abstract: OBJECTIVE
  The objective of this study was to demonstrate and quantify the ultrasound-guided percutaneous tracheostomy (UPDT) learning curve in a single team since the first UPDT.
  
  
  METHODS
  This was a cohort of all consecutive patients undergoing UPDT in the Amiens teaching hospital surgical intensive care unit between 2010 and 2014.
  
  
  METHODS
  The learning process was evaluated according to three aspects: duration of the various steps involved in UPDT, incidence of consecutive complications, and procedure difficulty.
  
  
  RESULTS
  During the study period, 85 consecutive patients underwent UPDT with no deaths. The mean total procedure time was 22 (10) minutes (range: 7 to 60). Analysis of mean cumulative UPDT procedure times showed that total UPDT time decreased to a stable duration of 25minutes after 54 procedures. Complications were observed in 24 (28%) of the 85 patients. The overall complication rate decreased to below a stable percentage of 30% after 70 procedures. The minor complication rate decreased below 25% after 64 procedures. The moderate complication rate decreased to below a stable percentage of 10% after 10 procedures. The major complication rate decreased to below a stable percentage of 5% after 20 procedures. Most complications were observed in the first 50 patients (25 [50%] versus 6 [13%], P<0.05).
  
  
  CONCLUSIONS
  Our study demonstrated that UPDT is associated with a fairly long learning curve. At least 50 procedures are necessary to perform UPDT with an acceptable complication rate and procedure time.
authors.affiliation: Department of anaesthesiology and critical care medicine, Amiens university hospital, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Petiot
authors.affiliation: Department of anaesthesiology and critical care medicine, Amiens university hospital, place Victor-Pauchet, 80054 Amiens, France. Electronic address: guinotpierregregoire@gmail.com.
authors.forename: Pierre-Grégoire
authors.initials: PG
authors.lastname: Guinot
authors.affiliation: Centre de recherche clinique, CHU d'Amiens, 80054 Amiens, France.
authors.forename: Momar
authors.initials: M
authors.lastname: Diouf
authors.affiliation: Department of anaesthesiology and critical care medicine, Amiens university hospital, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.affiliation: Department of anaesthesiology and critical care medicine, Amiens university hospital, place Victor-Pauchet, 80054 Amiens, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D010348:Patient Care Team; D011183:Postoperative Complications; D014139:Tracheostomy / Q000009:adverse effects / Q000193:education*; D018084:Ultrasonography, Interventional
chemical_list: D010100:Oxygen
keywords: Learning curve; Percutaneous tracheostomy; Ultrasound