Comparison of Traditional Landmark versus Ultrasound Guided Placement of Percutaneous Tracheostomies in Adult Intensive Care Patients -­ A Randomised Controlled Trial

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The TARGET Study is a prospective, randomised controlled trial, evaluating two standard techniques of tracheal puncture during insertion of percutaneous tracheostomies: the traditional landmark method versus the ultrasound guided method. Percutaneous Dilatational Tracheostomy (PTD) is a frequently performed invasive procedure in the Intensive Care setting, where complications both immediate and short term can contribute to significant morbidity and mortality. It is increasingly recognised that lateral (off midline) and cranio­caudal (too high up or too low down) malposition of PDTs may result in greater incidence of both short and long term complications. The use of ultrasonography in placing tracheostomies is well described in the literature. We aim to evaluate the use of real­time ultrasound guidance for the tracheal puncture, which is the most important determining element in positioning the tracheostomy, to determine which method results in better midline and cranio­caudal placement. Better midline and cranio-caudal placement in turn may decrease complications and improve clinically significant surrogate markers of outcome.