Comparison of Fiberoptic Bronchoscopy versus Landmark Technique for the quick insertion of Percutaneous Dilatation Tracheostomy Tub

Sanum Kashif; Ahmed  Burki; Fatima Tassadaq Syed

doi:10.51253/pafmj.v76iSUPPL-3.13857

Authors

Sanum Kashif Department of Critical Care Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Ahmed Burki Department of Critical Care Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Fatima Tassadaq Syed Department of Critical Care Medicine, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-3.13857

Keywords:

Fiberoptic Bronchoscopy, Insertion, Landmark Technique, Percutaneous Dilatation Tracheotomy

Abstract

Objective: To Compare Fiberoptic Bronchoscopy (FOB) versus Landmark technique for the quick insertion of Percutaneous Dilatation Tracheostomy Tube (PCDT).

Study Design: Quasi-experimental study.

Place and Duration of Study: Surgical ICU, Combined Military Hospital, Rawalpindi Pakistan, from Aug 2024 to May 2025.

Methodology: Patients were randomly divided into two groups via lottery method. In Group-A, Fiberoptic Bronchoscopy used for PCDT and in Group-B, Landmark technique was used for the insertion of PCDT tube. Correct placement of the endotracheal tube was ascertained by the chest x-ray in both the groups. The primary outcome was the procedural time of successful airway establishment and Secondary outcomes included complications (bleeding, hypoxia and esophageal injury).

Results: A total of 78 patients were included in the study. Procedural time was significantly longer in Fiberoptic Bronchoscopic group as compare to Landmark technique group (vs. 18.4±8.1 versus 12.9±4.7 min, p<0.01). Complications including, Bleeding (>50 mL) 15% in Group-A versus 9% in Group-B, Hypoxia was observed in 13% in Group-A versus 6% of cases in Group-B, whereas esophageal injury was not found in any of the group.

Conclusion: Percutaneous dilatation tracheostomy (PCDT) insertion with a landmark technique demonstrated superior performance in terms of procedural time as well as complications as compared to the fiberoptic bronchoscope technique.

Downloads

Download data is not yet available.

References

1. Ghattas C, Alsunaid S, Pickering EM, Holden VK. State of the art: percutaneous tracheostomy in the intensive care unit. J Thorac Dis 2021; 13(8): 5261-5270.

https://doi.org/10.21037/jtd-21-918

2. Mehta C, Mehta Y. Percutaneous tracheostomy. Ann Card Anaesth 2017; 20(Suppl 1): S19-25.

https://doi.org/10.4103/aca.ACA_36_17

3. Brass P, Hellmich M, Ladra A, Ladra J, Wrzosek A. Percutaneous techniques versus surgical techniques for tracheostomy. Cochrane Database Syst Rev 2016; (7): CD008045.

https://doi.org/10.1002/14651858.CD008045

4. Klotz R, Probst P, Deininger M, Klaiber U, Grummich K, Diener MK, et al. Percutaneous versus surgical strategy for tracheostomy: a systematic review and meta-analysis of perioperative and postoperative complications. Langenbecks Arch Surg 2018; 403(2): 137-149.

https://doi.org/10.1007/s00423-017-1636-5

5. Uluç K, Öngel EA, İlkaya NK, Devran Ö, Özçelik HK. Indication, complication, and prognosis of fiberoptic bronchoscopy guided percutaneous dilatation tracheostomy in respiratory intensive care unit: a retrospective study. Eur Rev Med Pharmacol Sci 2023; 27(24): 11245-53.

https://doi.org/10.26355/eurrev_202312_34190

6. Kumar P, Kumar S, Hussain M, Singh R, Ahmed W, Anand R, et al. Comparison of percutaneous tracheostomy methods in ICU patients: conventional anatomical landmark method versus ultrasonography method—a randomized controlled trial. Indian J Anaesth 2022; 66(Suppl 4): S207-212.

https://doi.org/10.4103/ija.ija_41_22

7. Zhang X, Zheng Y, Wang Z, Huang Y, Wang J, Jia L, et al. Comparison between fiberoptic bronchoscope-guided and landmark-based percutaneous dilatational tracheostomy: a systematic review and meta-analysis. J Intensive Care Med 2023; 38(3): 271-281.

https://doi.org/10.1177/08850666221123235

8. Kang HT, Kim SY, Lee MK, Lee SW, Baek A, Park KN, et al. Comparison between real-time ultrasound-guided percutaneous tracheostomy and surgical tracheostomy in critically ill patients: a randomized controlled trial. Crit Care Res Pract 2022; 1388225.

https://doi://doi.org/10.1155/2022/1388225

9. Kumar P, Gupta A, Singh PK, Pandey S, Agarwal S, Singh U. Fiberoptic bronchoscopy versus mini-surgical technique for percutaneous dilatational tracheostomy: a randomized controlled trial. J Intensive Care Med 2021; 36(8): 891-900.

https://doi.org/10.1177/0885066620928294

10. Tariparast PA, Brockmann A, Hartwig R, Benscheidt B, Klemm K, Bohr C, et al. Percutaneous dilatational tracheostomy with single-use bronchoscopes versus reusable bronchoscopes – a prospective randomized trial (TraSUB). BMC Anesthesiol 2022; 22: 90.

https://doi.org/10.1186/s12871-022-01618-4

11. Johnson-Obaseki S, Veljkovic A, Javidnia H. Complication rates of open surgical versus percutaneous tracheostomy in critically ill patients. Laryngoscope 2016; 126(11): 2459-2467.

https://doi.org/10.1002/lary.26019

12. Gupta S, Tomar DS, Dixit S, Zirpe K, Choudhry D, Govil D, et al. Dilatational percutaneous vs surgical tracheostomy in intensive care unit: a practice-pattern observational multicenter study (DISSECT). Indian J Crit Care Med 2020; 24(7): 514-521.

https://doi.org/10.5005/jp-journals-10071-23463

13. Iftikhar IH, Teng S, Schimmel M, Duran C, Sardi A, Islam S, et al. A network comparative meta-analysis of percutaneous dilatational tracheostomies using anatomic landmarks, bronchoscopic, and ultrasound guidance versus open surgical tracheostomy. Lung 2019; 197(3): 267-275.

https://doi.org/10.1007/s00408-019-00230-7

14. Nikbakhsh N, Amri F, Monadi M, Amri P, Bijani A. Semi-surgical percutaneous dilatational tracheostomy vs. conventional percutaneous dilatational tracheostomy: a prospective randomized trial. Casp J Intern Med 2021; 12(3): 249-256. http://doi.org/10.22088/cjim.12.3.249

15. Aly NM, Labib HA, Mohamed WA, Elbatsh YA. Ultrasound-guided percutaneous tracheostomy versus conventional tracheostomy: technique and outcome. Med J Cairo Univ 2021; 89(2): 233-241.

https://doi.org/10.21608/mjcu.2021.194984

16. Raimondi N, Vial MR, Calleja J, Quintero A, Cortés A, Celis E, et al. Evidence-based guidelines for the use of tracheostomy in critically ill patients. J Crit Care 2017; 38(1): 304-318.

https://doi.org/10.1016/j.jcrc.2016.10.020

17. Shen G, Yin H, Cao Y, Zhang M, Wu J, Jiang X, et al. Percutaneous dilatational tracheostomy versus fibre-optic bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomized controlled trial. Ir J Med Sci 2019; 188(2): 675-681.

https://doi.org/10.1007/s11845-018-1878

18. Lin KT, Kao YS, Chiu CW, Lin CH, Chou CC, Hsieh PY, et al. Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: a systematic review and meta-analysis. PLoS One 2021; 16(10): e0258972.

https://doi.org/10.1371/journal.pone.0258972

19. Topcu H, Ozçiftçi S, Şahiner Y. Comparative effectiveness of real-time ultrasound-guided tracheostomy and anatomic landmark percutaneous dilatational tracheostomy: a retrospective cohort study. Eur Rev Med Pharmacol Sci 2022; 26(21): 7910-7917.

20. Latial T, Shree S, Mishra K, Mishra S, Mustajab MA, Gupta M, et al. Comparison of percutaneous single-stage dilatational tracheostomy and surgical tracheostomy in critically ill patients: a randomized controlled trial. Int J Crit Illness Inj Sci 2024; 14(1): 9-14.

https://doi.org/10.4103/ijciis.ijciis_53