(1059) A Novel Visual-Guided Technique With Transillumination for Percutaneous Tracheal Placement

Introduction: Percutaneous tracheostomy (PT) is common in critical care but has complications such as malpositioning, bleeding, and tracheal ring rupture. This study evaluates the feasibility, safety, and efficacy of the Illuminated Tracheal Alignment Guide (iTAG) device for PT to reduce these complications, expand patient candidacy, and improve proceduralist confidence.

Methods: An interventional pilot study was conducted on 29 neurocritical care patients requiring tracheostomy from January 2023 to May 2024. Patients were included based on specific criteria and excluded for poor anatomy or significant vascular overlap. The iTAG method, using a laser light source and a needle guide with a hard stop, was employed. Data on demographics, procedure details, and early complications were collected. Historical control data from 57 patients who underwent standard tracheostomy (ST) between October 2008 and December 2010 were used for comparison. Statistical analyses included descriptive statistics, Pearson correlation coefficients, multiple regression analysis, independent t-tests, and chi-square tests.

Results: The mean time from intubation to tracheostomy for the iTAG group was 15.69 days, with a mean ICU length of stay (LOS) of 31.14 days. The iTAG group experienced significantly fewer early complications compared to the historical ST controls, including reduced hemorrhage (p < 0.05). There were no instances of tracheal ring fracture, posterior wall injury, or pneumothorax in the iTAG group. The iTAG method enabled safe PT in patients with challenging anatomies, including those with higher BMI.

Conclusions: The iTAG device enhances the safety and efficacy of PT by providing precise visualization and plunge proof mechanism, reducing early complications. Its use expands patient candidacy for PT and offers a valuable tool for training less-experienced practitioners. In our study, half of the procedures were performed by advanced practice providers under attending supervision. Further research with larger cohorts and randomized controlled trials is needed to confirm these findings and to establish the iTAG method as a standard of care for PT.