Tracheostomy is a vital procedure in the ICU for patients on mechanical ventilation, offering benefits such as reduced sedation, improved comfort, early rehabilitation, and shorter weaning periods. Traditionally performed using open techniques, these methods are now largely reserved for cases where percutaneous approaches are contraindicated, such as in patients with anatomical challenges like neck obesity or abnormal neck length. The percutaneous technique, particularly Ciaglia’s method involving sequential dilation and guidewire insertion, has become the preferred approach due to its bedside feasibility, resource efficiency, and ability to be performed by intensive care physicians rather than surgeons.
Guidance methods for percutaneous tracheostomy include anatomical landmarks, bronchoscopy, or ultrasound. While anatomical landmarks are commonly used, they may fail to detect anatomical variations like aberrant vascular paths, increasing the risk of complications such as bleeding, airway loss, pneumothorax, or tracheal injuries. Guidance through bronchoscopy or ultrasound enhances success rates on the first attempt, simplifies the procedure, and reduces complication risks. Notably, ultrasound guidance is emerging as a superior option in ICU settings due to its accessibility, reduced personnel requirements, and comparable safety to bronchoscopy. It enables real-time visualization of critical structures, aiding in precise puncture and dilation.
Despite its advantages, the ultrasound-guided approach lacks standardization and requires extensive training, which may account for variability in outcomes across studies. This article outlines a risk-based protocol using Ciaglia’s technique for ultrasound-guided percutaneous tracheostomy. The protocol emphasizes safety and efficiency, aiming to mitigate risks and streamline the learning curve for ICU clinicians. By integrating ultrasound, this approach addresses anatomical uncertainties, improves procedural outcomes, and enhances patient safety in resource-limited settings.
