Application of modified ultrasound-guided percutaneous dilatational tracheostomy in the intensive care unit

Objective: This randomized controlled trial compared the intraoperative performance, postoperative safety profiles, and clinical outcomes between modified ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) and conventional fiberoptic bronchoscopy-assisted PDT (FB-PDT) in critically ill patients within the Emergency Intensive Care Unit (EICU), aiming to establish an optimized tracheostomy protocol for high-risk populations. Methods: Between January 2023 and March 2025, 72 consecutive intubated patients requiring PDT were prospectively enrolled and randomly allocated to either the US-PDT group (n = 36) or the FB-PDT group (n = 36). Standardized protocols were implemented for sedation, anatomical localization, and procedural execution. Key metrics included intraoperative hemodynamic stability, procedure duration, complication rates, and recovery parameters. Results: The US-PDT group demonstrated significant advantages over the FB-PDT group, including shorter procedural time (9.25 ± 2.06 vs. 10.31 ± 1.86 min, P = 0.031), reduced intraoperative hemodynamic fluctuations (mean arterial pressure variation: 7.75 ± 5.79 vs. 10.81 ± 6.39 mmHg, P = 0.037), and lower rates of postoperative complications such as bleeding (7.56 ± 2.12 vs. 8.78 ± 1.90 mL, P = 0.012) and hypoxia (5.6% vs. 22.2%, P = 0.041). Clinically, US-PDT correlated with shorter mechanical ventilation duration (10.19 ± 1.43 vs. 10.94 ± 1.35 days, P = 0.025) and accelerated EICU discharge (15.39 ± 3.38 vs. 17.50 ± 3.50 days, P = 0.11). Conclusion: Modified US-PDT offers superior precision, safety, and clinical efficacy compared to bronchoscopy-assisted techniques in the EICU setting. Its integration into critical care protocols may reduce procedural risks, enhance recovery trajectories, and optimize resource utilization.