Different Techniques for Facilitating Percutaneous Dilatational Tracheostomy in Critically Ill Patients and Their Impact on Outcomes: A Single-Center Retrospective Cohort Study

Objective: Prolonged intubation in critically ill patients can lead to airway injury and infection. Early percutaneous dilational tracheostomy (PDT) is preferred in the intensive care unit (ICU), but the optimal guidance technique remains debated. We aimed to compare outcomes of PDT facilitated by three different guidance techniques: blind landmark, bronchoscopy-guided, and ultrasound-guided. Methods: This single-center retrospective cohort study included adults who underwent bedside PDT between 2013 and 2023. Patients were grouped by technique: bronchoscopy-guided (Group A), ultrasound-guided (Group B), and blind landmark technique (Group C). Demographics, illness severity, procedural details, complications, infection rates, and outcomes including mortality were analyzed. Results: A total of 254 patients were analyzed (118 bronchoscopy-guided, 50 ultrasound-guided, and 86 blind). Baseline illness severity scores were comparable among groups, although admission diagnosis distributions differed significantly. Tracheostomy-related complications occurred in 32% of patients, most commonly minor bleeding (~23%), with no significant intergroup differences. Early mortality following PDT (≤72 h) and post-procedural complication rates were similar among techniques. Pneumothorax and tracheoesophageal fistula were rare events. Ventilator liberation and decannulation rates did not differ significantly between groups. ICU and hospital mortality were numerically higher in the blind group; however, these findings should be interpreted cautiously because of the retrospective design and differences in admission diagnoses and case-mix between groups. Conclusions: All three PDT guidance techniques showed comparable procedural safety, with no significant differences in early complications, infection rates, or ventilator liberation. Although blind PDT was associated with higher observed mortality, this cannot be causally attributed to the technique, given the retrospective design and potential confounders. Ultrasound guidance offers practical procedural advantages and should be considered where available, pending prospective randomized confirmation.