Comparison of the Efficacy and Safety of Ultrasound-Guided Percutaneous Balloon Dilatational Tracheotomy and Surgical Tracheotomy in Patients With Acute Respiratory Failure

AIM: This study aimed to compare the efficacy and safety of ultrasound-guided percutaneous balloon dilatational tracheotomy (US-PDT) versus surgical tracheotomy (ST) in patients with acute respiratory failure (ARF). METHODS: In this retrospective cohort study, 278 patients with ARF were enrolled from January 2022 to January 2025. These patients were divided into the US-PDT group (n = 135) and the ST group (n = 143) based on the surgical method used. Perioperative indicators, procedural success rates, inflammatory markers, hospitalization outcomes, and complications were systematically compared between the two groups. RESULTS: The US-PDT group demonstrated superior outcomes across all measures. It was associated with a significantly shorter procedure time, smaller incision length, reduced intraoperative blood loss, and shorter duration of mechanical ventilation (all p < 0.001). The US-PDT group also showed a higher single-attempt procedural success rate, alongside a lower accidental extubation rate (all p < 0.001). Postoperative inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]) were significantly lower in the US-PDT group (p < 0.001). Furthermore, the US-PDT group experienced reduced ventilator-associated pneumonia (VAP) incidence, higher weaning success, shorter intensive care unit (ICU) and hospital stays, and lower ICU and overall mortality (all p < 0.05). Complication rates were also significantly lower in the US-PDT group (p < 0.05). CONCLUSIONS: US-PDT is a more efficient, safer, and less invasive alternative to ST for ARF patients, resulting in better clinical outcomes, reduced inflammation, fewer complications, and improved survival rates.