Percutaneous Dilatational Tracheostomy and Thyroid Isthmus Penetration (Petris)

Objective To evaluate the clinical relevance of thyroid isthmus penetration during percutaneous dilatational tracheostomy (PDTS) and to explore the role of ultrasound (US) in procedural guidance and patient selection. Design Single-center, prospective interventional study. Setting Intensive care unit of a tertiary academic hospital. Patients Adult patients requiring tracheostomy due to prolonged mechanical ventilation or neurological impairment. Interventions Following pre-procedural ultrasound assessment, patients deemed suitable for PDTS were allocated to either a landmark-based technique (Group A) or ultrasound-guided technique (Group B). Ultrasound was also used for post-puncture documentation of guidewire position. Bronchoscopic verification was performed in all cases. Measurements and Main Results: Among 180 tracheostomies performed, 100 PDTS procedures were analyzed (51 Group A, 49 Group B). In 68% of cases, the tracheostomy trajectory traversed the thyroid isthmus. Early complication rates were similar between trans-isthmic and non-trans-isthmic procedures (4.4% vs. 3.1%; p = 1.00) and between Group A and Group B (2.0% vs. 6.1%; p = 0.342). Compared with surgical tracheostomy, PDTS demonstrated a lower observed complication rate (4.0% vs. 23.9%; p < 0.001), although this comparison was confounded by baseline differences. Bronchoscopic inspection prompted guidewire repositioning in 5% of cases. Conclusions Trans-isthmic PDTS is common and, within this preselected cohort, was not associated with a higher observed rate of early complications. Pre-procedural ultrasound appears valuable for anatomical assessment and patient selection, while the additional benefit of intra-procedural ultrasound guidance in reducing early complications was not demonstrated. These findings are exploratory and should be confirmed in larger studies. Clinical Trial Registration The study was registered with ClinicalTrials.gov (NCT 05792098; March 30, 2023).