ABSTRACT Objectives Percutaneous dilatational tracheostomy (PDT) is increasingly preferred in intensive care due to its procedural efficiency. Standard approaches typically rely on real‐time bronchoscopic or ultrasound guidance, which may be unavailable in resource‐limited settings. We evaluated the feasibility, safety, and learning curve of landmark‐guided PDT performed without adjunctive visualization. Methods We retrospectively analyzed 71 consecutive adult patients who underwent landmark‐guided PDT without bronchoscopic or ultrasound guidance between August 2024 and June 2025. All procedures were performed by a head and neck surgeon newly trained in PDT. Outcomes included procedure duration, complication rates, and patient‐specific predictors of procedural difficulty. The learning curve was assessed using correlation and linear regression, and independent predictors of prolonged procedure time were identified through multivariable linear modeling. Results The median procedure time was 7.0 (3.0–54.0) min, and a significant learning curve was observed (r = −0.41; p < 0.001). Complications occurred in 14.1% of patients, with major events being limited to one bleeding episode and two pneumothoraces. In multivariable analyses, prior cerebrovascular accident and increased cricoid–manubrium distance independently predicted prolonged procedure times. Conclusion Landmark‐guided PDT without real‐time visualization was feasible and safe following a brief learning phase. With appropriate patient selection and operator training, this technique may represent a practical alternative in settings where visualization adjuncts are unavailable. Level of Evidence 4.
Lee et al. (Sat,) studied this question.