Learning curve for real-time ultrasound-guided percutaneous tracheostomy

Sandra Petiot (1) , Pierre-Gregoire Guinot (1) , Momar Diouf (2) , Elie Zogheib (3) , Herve Dupont (4, 5)

1 Service d'anesthésie et de soins intensifs
2 Direction de la recherche clinique et de l'innovation [CHU Amiens]
3 Mécanismes physiologiques et conséquences des calcifications cardiovasculaires: rôle des remodelages cardiovasculaires et osseux
4 CHU Amiens-Picardie
5 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517

Objectives: The objective of this study was to demonstrate and quantify the ultrasound-guided percutaneous tracheostomy (UPDT) learning curve in a single team since the first UPDT. Study design and patients: This was a cohort of all consecutive patients undergoing UPDT in the Amiens teaching hospital surgical intensive care unit between 2010 and 2014. Methods: The learning process was evaluated according to three aspects: duration of the various steps involved in UPDT, incidence of consecutive complications, and procedure difficulty. Results: During the study period, 85 consecutive patients underwent UPDT with no deaths. The mean total procedure time was 22 (10) minutes (range: 7 to 60). Analysis of mean cumulative UPDT procedure times showed that total UPDT time decreased to a stable duration of 25 minutes after 54 procedures. Complications were observed in 24 (28%) of the 85 patients. The overall complication rate decreased to below a stable percentage of 30% after 70 procedures. The minor complication rate decreased below 25% after 64 procedures. The moderate complication rate decreased to below a stable percentage of 10% after 10 procedures. The major complication rate decreased to below a stable percentage of 5% after 20 procedures. Most complications were observed in the first 50 patients (25 [50%] versus 6 [13%], P < 0.05). Conclusions: Our study demonstrated that UPDT is associated with a fairly long learning curve. At least 50 procedures are necessary to perform UPDT with an acceptable complication rate and procedure time. (C) 2016 Societe francaise d'anesthesie et de reanimation (Sfar). Published by Elsevier Masson SAS. All rights reserved.

Domaines: Sciences du Vivant [q-bio]

Sandra Petiot, Pierre-Gregoire Guinot, Momar Diouf, Elie Zogheib, Herve Dupont. Learning curve for real-time ultrasound-guided percutaneous tracheostomy. Anaesthesia Critical Care & Pain Medicine, 2017, 36 (5), pp.279-283. ⟨10.1016/j.accpm.2016.07.005⟩. ⟨hal-03577557⟩