Ultrasound-guided tracheostomy proves safe option in COVID-19 ICU patients

Patients with severe COVID-19 who underwent ultrasound-guided percutaneous dilatation tracheostomy at a Croatian specialist intensive care unit experienced complication rates comparable to those seen with the conventional bronchoscopy-guided technique used before the pandemic, according to a retrospective cohort study published in BMC Anesthesiology.

The study, conducted at the Clinical Hospital Centre Rijeka, examined all patients admitted to the hospital’s specialized COVID-19 ICU department between March 28, 2020, and December 31, 2021. During this period, 825 patients were hospitalized because of COVID-19 respiratory failure.

The technique was chosen for a specific pandemic-era reason. While bronchoscopy-guided methods were the conventional approach, ultrasound guidance offered a practical advantage during the pandemic: it minimizes the formation and dissemination of aerosols. The procedure was also performed with limited medical staff, using a two-operator technique that the authors describe as a balance between protecting personnel and maintaining quality of care for patients.

The tracheostomy cohort was predominantly male, with 70 of the 99 patients, or 70.7 percent, being men. The overall median age was 67 years, with patients ranging from 36 to 87 years old. The researchers analyzed demographic data, the duration of mechanical ventilation both before and after the ultrasound-guided procedure, and whether patients were successfully weaned off the ventilator.

Weaning from mechanical ventilation proved successful in 54 of the 99 patients, a rate of 54.55 percent. Notably, the researchers found no significant difference in weaning success with respect to gender, the duration of mechanical ventilation, the type of percutaneous dilatation tracheostomy performed, or the infectious period during which the procedure took place.

To place these outcomes in context, the team compared the COVID-19-era results with those of patients who received bronchoscopy-guided percutaneous dilatation tracheostomy at the same hospital in 2012 and 2013, before the pandemic. This comparison revealed a significant overall increase in the number of tracheostomies performed during the COVID-19 period, with a p value below 0.01. The procedure was also performed significantly later in the course of illness, with a p value below 0.0001, and significantly fewer patients were successfully weaned from mechanical ventilation in the COVID-19 group, also with a p value below 0.0001.

Crucially, however, no significant difference in the occurrence of complications was observed between the two techniques across the studied periods. The authors conclude that their experience demonstrates the effectiveness, safety, and non-inferiority of the ultrasound-guided approach over bronchoscopy-guided techniques, that it minimizes aerosol spread, and that it improves ventilation management while maintaining complication rates comparable to the pre-COVID period. They add that the two-operator method proved essential both under the overwhelming conditions of the pandemic and in situations of general medical staff shortage.

The findings should be read with the study’s design in mind. The article was published as an early-access, peer-reviewed accepted version, citable under a permanent DOI and subject to further edits before the final version of record appears.

Within those limits, the study offers intensive care teams a documented real-world experience: in 99 COVID-19 patients treated under pandemic constraints with reduced staffing, ultrasound-guided percutaneous dilatation tracheostomy achieved outcomes and complication rates consistent with the established bronchoscopy-guided method, while reducing aerosol generation during a period when airborne transmission of the virus was a central concern for frontline personnel.

Subject of Research: Ultrasound-guided percutaneous dilatation tracheostomy outcomes in COVID-19 ICU patients compared with pre-pandemic bronchoscopy-guided tracheostomy

Article Title: Ultrasound-guided percutaneous dilatation tracheostomy demonstrates efficacy and safety in patients with COVID-19: a retrospective cohort study

Article References: Bašagić, N., Šustić, A., Protić, A., & Tomulić Brusich, K. (2026). Ultrasound-guided percutaneous dilatation tracheostomy demonstrates efficacy and safety in patients with COVID-19: a retrospective cohort study. BMC Anesthesiology. https://doi.org/10.1186/s12871-026-04344-3

Image Credits: AI Generated

DOI: 10.1186/s12871-026-04344-3

Keywords: COVID-19, tracheostomy, ultrasound-guided procedure, percutaneous dilatation tracheostomy, mechanical ventilation, intensive care, retrospective cohort study, aerosol minimization, weaning, bronchoscopy guidance, BMC Anesthesiology, Croatia