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Review
. 2006;10(2):R55.
doi: 10.1186/cc4887.

Percutaneous Dilatational Tracheostomy Versus Surgical Tracheostomy in Critically Ill Patients: A Systematic Review and Meta-Analysis

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Free PMC article
Review

Percutaneous Dilatational Tracheostomy Versus Surgical Tracheostomy in Critically Ill Patients: A Systematic Review and Meta-Analysis

Anthony Delaney et al. Crit Care. .
Free PMC article

Abstract

Introduction: Tracheostomy is one of the more commonly performed procedures in critically ill patients yet the optimal method of performing tracheostomies in this population remains to be established. The aim of this study was to systematically review and quantitatively synthesize all randomized clinical trials (RCTs), comparing elective percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in adult critically ill patients with regards to major short and long term outcomes.

Methods: MEDLINE, EMBASE, CINAHL and the Cochrane Controlled Clinical Trials Register databases were searched to identify relevant studies. Additionally, bibliographies and selected conference proceedings were reviewed, and experts in the field and manufacturers of two PDT kits were contacted. Randomized clinical trials comparing any method of elective PDT to ST that included critically ill adults and reported at least one clinically relevant outcome were included. Data extracted included trial characteristics, measures of study validity, and clinically relevant outcomes.

Results: Seventeen RCTs involving 1,212 patients were included. Most PDTs used a multiple dilator technique and were performed in the intensive care unit (ICU). The pooled odds ratio (OR) for wound infection was 0.28 (95% confidence interval (CI), 0.16 to 0.49, p < 0.0005), indicating a significant reduction with PDT compared to ST. Overall, PDT was equivalent to ST for bleeding, major peri-procedural and long-term complications; however, subgroup analysis suggested PDT resulted in a lower incidence of bleeding (OR = 0.29 (95% CI 0.12 to 0.75, p = 0.01)) and death (OR = 0.71 (95% CI 0.50 to 1.0, p = 0.05)) when the STs were performed in the operating theatre.

Conclusion: PDT reduces the overall incidence of wound infection and may further reduce clinical relevant bleeding and mortality when compared with ST performed in the operating theatre. PDT, performed in the ICU, should be considered the procedure of choice for performing elective tracheostomies in critically ill adult patients.

Figures

Figure 1
Figure 1
Quorum flow diagram summarizing trial flow and reasons for exclusion of studies. PDT, percutaneous dilatational tracheostomy; RCT, randomized clinical trial.
Figure 2
Figure 2
Forest plot showing the effect of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) on the incidence of wound infection.
Figure 3
Figure 3
Forest plot showing the effect of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) on the incidence of significant bleeding.
Figure 4
Figure 4
Forest plot showing the effect of percutaneous dilatational tracheostomy (PDT) compared to surgical tracheostomy (ST) on mortality.

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References

    1. Walts PA, Murthy SC, DeCamp MM. Techniques of surgical tracheostomy. Clin Chest Med. 2003;24:413–422. doi: 10.1016/S0272-5231(03)00049-2. - DOI - PubMed
    1. Cox CE, Carson SS, Holmes GM, Howard A, Carey TS. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, 1993–2002. Crit Care Med. 2004;32:2219–2226. - PubMed
    1. Needham DM, Bronskill SE, Calinawan JR, Sibbald WJ, Pronovost PJ, Laupacis A. Projected incidence of mechanical ventilation in Ontario to 2026: Preparing for the aging baby boomers. Crit Care Med. 2005;33:574–579. doi: 10.1097/01.CCM.0000155992.21174.31. - DOI - PubMed
    1. Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;330:1243. doi: 10.1136/bmj.38467.485671.E0. - DOI - PMC - PubMed
    1. Freeman BD, Borecki IB, Coopersmith CM, Buchman TG. Relationship between tracheostomy timing and duration of mechanical ventilation in critically ill patients. Crit Care Med. 2005;33:2513–2520. doi: 10.1097/01.CCM.0000186369.91799.44. - DOI - PubMed
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