Non-bronchoscopic versus bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill trauma patients: a propensity score-matched retrospective cohort study

Abstract Background Percutaneous dilatational tracheostomy (PDT) is increasingly performed in intensive care units (ICUs). However, the necessity of bronchoscopic guidance and the clinical outcomes of PDT in patients with trauma remain unclear. Methods Data from patients who underwent PDT in the trauma ICU of a tertiary referral center were retrospectively reviewed. Patients were categorized into the non-bronchoscopic PDT (NB-PDT) and bronchoscopy-guided PDT (B-PDT) groups. A 1:1 propensity score matching was performed to balance baseline characteristics between the groups. The primary outcome was a composite procedure-related major complication, including major bleeding, ventilatory failure requiring tracheostomy tube reinsertion, and barotrauma. Results In the propensity score-matched cohort of 126 patients (63 pairs), the incidence of composite procedure-related major complications did not differ between the NB-PDT and B-PDT groups (7.9% vs. 1.6%; odds ratio [OR], 5.00; 95% confidence interval [CI], 0.58–42.8; P = 0.219). Among the secondary outcomes, the NB-PDT group required fewer additional intraprocedural bolus administrations (3 [2 – 3] vs. 4 [2–4]; median difference, -1 [95% CI, -1.5 to -0.5]; P < 0.001) and had a shorter procedure time (25 [20–30] vs. 30 [23–35]; median difference, -4 [95% CI, -7.5 to -0.5]; P = 0.022). Conclusion NB-PDT was not associated with an increased risk of procedure-related major complications compared with B-PDT and was associated with a shorter procedure time and fewer additional intraprocedural bolus administrations. NB-PDT may be a feasible alternative in trauma ICU patients.