Percutaneous tracheostomy in intensive care: How to improve the safety of the procedure?

Percutaneous tracheostomy (PT) is a common procedure in intensive care unit (ICU) patients. This method offers certain benefits compared to the traditional surgical technique, such as a lower infection rate. However, it is essential to consider its contraindications and potential complications. As with any procedure, following a learning curve is important to reduce the risk of complications. The use of ultrasound provides greater safety during PT by allowing the identification of anatomical structures and increasing the likelihood of a safe puncture, especially when performed in a protocolized manner. However, specific training is required to achieve adequate anatomical identification. The use of bronchoscopy is not routine and its role has become increasingly limited to patients with distorted anatomies. In summary, PT is a safe technique when performed by experienced personnel in the ICU, provided that there is adequate training and careful patient selection. Therefore, its practice should be part of the curriculum in critical care and intensive care medicine training programs.