Use of BUG-SAFE (Bougie guide safe percutaneous tracheostomy) to prevent airway loss in critically Ill patients: Cohort study

Background: The Bougie Guide Safe Percutaneous Tracheostomy (BUG-SAFE) technique is a novel approach designed to reduce airway loss and complications during tracheostomy in ventilated patients. Methods: We conducted a retrospective cohort study of ICU patients (2020–2023) undergoing tracheostomy with the BUG-SAFE technique to facilitate prolonged weaning from mechanical ventilation. Results: Of 1286 ICU admissions, 128 patients were included. Complications occurred in 17.2 % (mainly bleeding), and one death (0.7 %) was reported. No cases of hypoxemia or airway loss were observed. Risk of complications was associated with ICU stay, ventilation duration, APACHE II scores, and oxygen debt. BUG-SAFE showed a high sensitivity for detecting complication-related mortality. The technique also reduces aerosolization, enhancing safety for healthcare providers. Conclusions: BUG-SAFE is a safe, feasible bedside technique with low complication rates. It ensures airway security and minimizes aerosol generation, making it suitable for both patients and healthcare personnel.