الفهرس 
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Abstract
Tracheostomy procedure is considered as an important tool in the ICU .Its importance is increasing in patients with prolonged ventilation who require long term airway maintenance. ICU patients are mostly unstable, so the (PDT) is suitable for them as it does not necessitate to transfer patients to the operating theatre. Fiber-optic bronchoscopy provides many advantages during the PDT such as accurate puncture site detection, better visualization to the guide wire and the successive dilators and suctioning of any secretions have been found. Bronchoscopic guided PDT has been considered the routine method for PDT in many centers worldwide. But fiber-optic bronchoscopy has many complications as hypoxia, bleeding, and elevated intracranial pressure. Ultrasound becomes a potentially safe noninvasive useful tool .It can identify aberrant vessels in front of the neck to be avoided during the procedure and abnormal anatomical structures, to identify the puncture site and to guide the proceeding needle. Both procedures have been compared regarding both safety and efficacy with conflicting results .
This is interventional randomized controlled trial that was conducted at the critical care department Beni Suef University hospital, during the period between December 2017 and December 2019, on 30 adult prolonged ventilated patients and legible for tracheostomy.
Patients were divided into two groups:
group I: Ultrasound guided group
group II: Bronchoscopy guided group
All patients were subjected to full history , physical examination ,and routine labs
There was no statistically significant difference between both groups regarding age, gender and causes of admission, APACHE II score on admission, days of ICU admission before tracheostomy and ventilator days before tracheostomy
There was no statistically significant difference regarding number of puncture attempts, time of the procedure, site of entry
There was no significant difference between both groups in complications happened during the procedure except for transient hypoxemia and minor bleeding with increased incidence in the bronchoscopic guided group.
There was no significant difference between both groups in regarding ventilator days after the procedure, length of ICU stay, and final hospital outcome.