Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis
Top Cited Papers
Open Access
- 19 December 2014
- journal article
- research article
- Published by Springer Nature in Critical Care
- Vol. 18 (6), 1-21
- https://doi.org/10.1186/s13054-014-0544-7
Abstract
The aim of this study was to conduct a meta-analysis to determine whether percutaneous tracheostomy (PT) techniques are advantageous over surgical tracheostomy (ST), and if one PT technique is superior to the others. Computerized databases (1966 to 2013) were searched for randomized controlled trials (RCTs) reporting complications as predefined endpoints and comparing PT and ST and among the different PT techniques in mechanically ventilated adult critically ill patients. Odds ratios (OR) and mean differences (MD) with 95% confidence interval (CI), and I2 values were estimated. Fourteen RCTs tested PT techniques versus ST in 973 patients. PT techniques were performed faster (MD, −13.06 minutes (95% CI, −19.37 to −6.76 (P <0.0001)); I2 = 97% (P <0.00001)) and reduced odds for stoma inflammation (OR, 0.38 (95% CI, 0.19 to 0.76 (P = 0.006)); I2 = 2% (P = 0.36)), and infection (OR, 0.22 (95% CI, 0.11 to 0.41 (P <0.00001)); I2 = 0% (P = 0.54)), but increased odds for procedural technical difficulties (OR, 4.58 (95% CI, 2.21 to 9.47 (P <0.0001)); I2 = 0% (P = 0.63)). PT techniques reduced odds for postprocedural major bleeding (OR, 0.39 (95% CI, 0.15 to 0.97 (P = 0.04)); I2 = 0% (P = 0.69)), but not when a single RCT using translaryngeal tracheostomy was excluded (OR, 0.58 (95% CI, 0.21 to 1.63 (P = 0.30)); I2 = 0% (P = 0.89)). Eight RCTs compared different PT techniques in 700 patients. Multiple (MDT) and single step (SSDT) dilatator techniques are associated with the lowest odds for difficult dilatation or cannula insertion (OR, 0.30 (95% CI, 0.12 to 0.80 (P = 0.02)); I2 = 56% (P = 0.03)) and major intraprocedural bleeding (OR, 0.29 (95% CI, 0.10 to 0.85 (P = 0.02)); I2 = 0% (P = 0.72)), compared to the guide wire dilatation forceps technique. In critically ill adult patients, PT techniques can be performed faster and reduce stoma inflammation and infection but are associated with increased technical difficulties when compared to ST. Among PT techniques, MDT and SSDT were associated with the lowest intraprocedural risks and seem to be preferable.Keywords
This publication has 55 references indexed in Scilit:
- Early and late outcome after single step dilatational tracheostomy versus the guide wire dilating forceps technique: a prospective randomized clinical trialIntensive Care Medicine, 2011
- Intensive care unit tracheostomy: a snapshot of UK practiceInternational Archives of Medicine, 2008
- Percutaneous tracheostomy: A comparison of PercuTwist and multi-dilatators techniquesAnnals of Cardiac Anaesthesia, 2008
- PercuTwistEuropean Journal of Anaesthesiology, 2007
- Comparison of Two Methods to Detect Publication Bias in Meta-analysisJAMA, 2006
- Measuring inconsistency in meta-analysesBMJ, 2003
- Quantifying heterogeneity in a meta‐analysisStatistics in Medicine, 2002
- A comparison of percutaneous and operative tracheostomies in intensive care patientsCanadian Journal of Anesthesia/Journal canadien d'anesthésie, 1995
- Messy Methods for Communication ResearchJournal of Communication, 1995
- The Equivalence of Weighted Kappa and the Intraclass Correlation Coefficient as Measures of ReliabilityEducational and Psychological Measurement, 1973