Schwartz, Jacob

Background Bedside percutaneous dilatational tracheostomy is a commonly performed procedure in the Intensive Care Unit with a steep learning curve. Checklists and standardized protocols have been established as essential tools for mitigating medical error and enhancing patient safety during critical care procedures. Research Question To assess the feasibility and safety profile of a percutaneous tracheostomy protocol, performed by pulmonary and critical care fellows, which integrates a multi-component checklist, tracheal ultrasound and a unique dual-visualization technique for endotracheal tube management. Study Design and Methods We conducted a retrospective review of all patients (n = 49) who underwent bedside percutaneous tracheostomy using a standardized protocol between November 1, 2022, and October 31, 2024. Key components of the protocol included rigorous pre-procedure assessment with standard tracheal ultrasound stations, a mandatory checklist, and endotracheal tube retraction under dual video laryngoscopy and bronchoscopy. Outcomes analyzed included major bleeding, site infection, and airway complications. Results A total of 49 percutaneous tracheostomy procedures were successfully performed over the 24-month period. No major bleeding episodes or pressure ulcers were identified. There was a single complication involving loss of airway due to endotracheal tube balloon rupture. Critically, the patient was rapidly re-intubated without any hypoxemia or hemodynamic instability, which may be attributed to the immediate availability and use of the dual-visualization safeguard. Interpretation The implementation of this protocolized, checklist-driven approach to bedside percutaneous tracheostomy is feasible and safe within the framework of a pulmonary and critical care fellowship training model. The use of a novel dual-visualization technique (video laryngoscopy and bronchoscopy) during endotracheal tube retraction serves as a robust fail-safe, which may enhance patient safety during airway-compromised events.