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Publications

Journal Article Ahead of print

PubMed: 42217576 DOI: 10.1016/j.accpm.2026.101863

PERCUTANEOUS DILATATIONAL TRACHEOSTOMY AND THYROID ISTHMUS PENETRATION (PETRIS).

Anaesth Crit Care Pain Med

Authors: Aleš Rára, Michal Soták, Martin Hynek, Karol Kovačič, Tomáš Filipovský, Tomáš Tyll

Affiliations

  • Department of Anaesthesiology and Intensive Care of the 1st Faculty of Medicine and Military University Hospital Prague (ÚVN), Prague, Czechia.
  • Department of Anaesthesiology and Intensive Care of the 1st Faculty of Medicine and Military University Hospital Prague (ÚVN), Prague, Czechia.
  • Department of Gynaecology, Obstetrics and Neonatology, First Faculty of Medicine of Charles University and General University Hospital in Prague, Prague, Czechia.
  • Department of Radiodiagnostic, Military University Hospital in Prague (ÚVN), Prague, Czechia.
  • Department of Otorhinolaryngology and Maxillofacial Surgery of the 3rd Faculty of Medicine and Military University Hospital Prague (ÚVN), Prague, Czechia.

Abstract

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 (NCT05792098; March 30, 2023).

MeSH

Anesthesia, Tracheostomy, Thyroid Gland, Bronchoscopy