A standard tube versus the ultra-narrow Tritube^® during percutaneous dilatational tracheostomy: a randomized trial comparing droplet spread, complications, and duration

BACKGROUND: The choice of ventilation method during percutaneous dilatational tracheostomy (PDT) in intensive care units (ICUs) may influence procedure duration, complication rates, and the operator’s risk of exposure to droplets and aerosols. This study evaluates the effects of ventilation using the ultra-narrow Tritube^® on procedure duration, complication incidence, and droplet contamination of the operator during PDT. METHODS: A total of 32 patients underwent PDT procedures. Patients were randomly assigned to either the conventional group or the Tritube group. The conventional group underwent standard PDT, while the Tritube group was intubated with the Tritube and ventilated using the Evone^® ventilator in Flow Control Ventilation (FCV) mode. A sterile, transparent trestle table was positioned over the procedural area to facilitate contamination assessment. Procedure duration and all complications were systematically recorded. Surface swab specimens were aseptically collected before and after the procedure and analyzed for adenosine triphosphate (ATP) levels using a radioluminescence assay. RESULTS: The Tritube group demonstrated a significantly shorter procedure time (6.6±1.5 vs. 8±1.2 min; P=0.006) and a substantially lower complication rate (6.2% vs. 56.2%; P=0.002) compared to the conventional group. Additionally, the Tritube group exhibited significantly lower mean radioluminescence (relative light units, RLU) values (231±96 RLU vs. 6797±2692 RLU; P<0.001), indicating reduced contamination. No significant differences were observed between the groups in peak inspiratory pressure (PI_max), SpO₂, or P_EtCO₂. CONCLUSIONS: Tritube^® and the FCV approach may offer technique-specific advantages such as shorter procedure time, fewer complications, and less droplet contamination. Our findings suggest that this technique may be a promising ventilation strategy in PDT procedures.