Comparative analysis of the safety and efficacy of different visualization and control methods in performing percutaneous dilatational tracheostomy

Introduction. In modern clinical practice, three main techniques for percutaneous dilatational tracheostomy (PDT) are distinguished: the Griggs, Ciaglia, and Frova methods. Each of these techniques has its own technical features; however, all of them can be performed using various auxiliary imaging and monitoring methods. Despite the widespread use of PDT and the availability of different techniques and methods for its implementation, the question of selecting the optimal approach remains open and depends on the specific clinical situation. In conditions of mass patient admission and real clinical practice, it is not always possible to ensure the availability of a bronchoscope or a qualified ultrasound specialist. This dictates the necessity of finding the safest and most effective approach based on available resources and the training level of medical personnel [4, 8]. The objective was to perform a comparative analysis of the safety and efficacy of various PDT methods (under fiberoptic control, ultrasound control, and «blind»).
Materials and methods. The study was conducted at the I.F. Bush General Surgery Clinic of the S. M. Kirov Military Medical Academy, as a prospective single-center randomized clinical trial with simple computer randomization of patients using a random number generator. As a result, three comparable groups of 50 patients each were formed: Group 1 (FBS) – PDT under fiberoptic visual control; Group 2 (ultrasound) – PDT using ultrasound navigation; Group 3 – «blind» PDT (without the use of additional visualization tools). The primary endpoint of the study was the incidence of intraoperative and early postoperative complications. Secondary endpoints included the time required for preparation and performance of PDT.
Results. All three PDT techniques (FBS, ultrasound, and «blind») demonstrated a comparable safety profile. No statistically significant differences in the frequency of intraoperative and early postoperative complications were found between the groups (p > 0.05 for all comparisons). Procedure preparation time differed significantly between all methods (p < 0.001): the fastest method was «blind», and the slowest one was ultrasound. PDT performance time did not statistically differ across all groups (pairwise comparisons did not reveal significant differences) [1, 2].
Conclusions. The analysis of the obtained data indicates a low frequency of complications across all studied techniques. No statistically significant differences were identified between groups regarding the main types of complications, which allows for the conclusion of comparable safety between fiberoptic bronchoscopy, ultrasound control, and «blind» intervention under the conditions of this study. The absence of severe complications in all groups further confirms the high safety profile of the considered techniques. The method of visualization has a significant impact on the time required for PDT preparation. The time required to perform the procedure does not depend on the chosen visualization method.

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