Percutaneous and surgical tracheostomy in critically ill adult patients: a meta-analysisReport as inadecuate




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Critical Care

, 18:544

First Online: 19 December 2014Received: 10 February 2014Accepted: 11 September 2014

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 I 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; I = 97% P <0.00001 and reduced odds for stoma inflammation OR, 0.38 95% CI, 0.19 to 0.76 P = 0.006; I = 2% P = 0.36, and infection OR, 0.22 95% CI, 0.11 to 0.41 P <0.00001; I = 0% P = 0.54, but increased odds for procedural technical difficulties OR, 4.58 95% CI, 2.21 to 9.47 P <0.0001; I = 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; I = 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; I = 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; I = 56% P = 0.03 and major intraprocedural bleeding OR, 0.29 95% CI, 0.10 to 0.85 P = 0.02; I = 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.

AbbreviationsBDTballoon dilation tracheostomy

CIconfidence interval

GWDFguide wire dilatation forceps technique

MDTmultiple dilatator techniques

PTpercutaneous tracheostomy

RCTrandomized controlled trial

RDTrotational dilation tracheostomy

SSDTsingle-step dilatator technique

STsurgical tracheostomy

TLTtranslaryngeal tracheostomy

Electronic supplementary materialThe online version of this article doi:10.1186-s13054-014-0544-7 contains supplementary material, which is available to authorized users.

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Author: Christian Putensen - Nils Theuerkauf - Ulf Guenther - Maria Vargas - Paolo Pelosi

Source: https://link.springer.com/







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