Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysis

Abstract

IntroductionThe 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.MethodsComputerized 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.ResultsFourteen 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.ConclusionIn 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-014-0544-7) contains supplementary material, which is available to authorized users.

Airway Management during MS-PDT Using I-GEL: A Case Report

“…As initially stated, optic fiber bronchoscope can be used to identify the endotracheal structures; however, in this method it was not required to use optic fiber bronchoscope. It had more ease and less time to do with no side effects (6)(7)(8). Unwanted puncture of the bottom of endotracheal tube is also avoided and the possibility of wrong entrance of guide needle is reduced (1,6,9).…”

“…In case of mediastinitis, only 2 studies were done after this method; also, they had no deal with mediastinitis after PDT in 24 hours (Fernandez-Linsted) (8,10,11 In studies, there should be a great attention on the side effects such as gastric distention, mild bleeding, arrhythmia, desaturation, subcutaneous emphysema, and tracheal stenosis, which were mentioned in the study group (SGA). However, the responses in this case were contradictory and required further studies (11)(12)(13).…”

Awake percutaneous tracheostomy as an alternative to open emergency tracheostomy in a threatened airway

“…The use of dilatation rather than sharp dissection to form the stoma has also been associated with reduced infectious complications. 24 …”

Tracheoscopic ventilation tube: a new step towards safer tracheostomy?

“…Nowadays, in the intensive care unit (ICU), the typical situation is PDT performed at bedside by ICU physician [7]. The key points of this widespread use are ease and safety [8][9][10].…”

“…The safety mainly results of the ease: a shorter procedure length compared to the surgical method reduces the stoma infection risk [8,9,12], while the risk for complications during the procedure is reduced. However, serious adverse events are still reported [13,14].…”