Percutaneous tracheostomy, a systematic review

Background: Percutaneous dilatational tracheostomy (PDT) is
a common procedure in intensive care units and the identification
of the best technique is very important. We performed a
systematic review and meta-analysis of randomized studies
comparing different PDT techniques in critically ill adult patients
to investigate if one technique is superior to the others with
regard to major and minor intraprocedural complications.
Methods: BioMedCentral and other database of clinical trials
were searched for pertinent studies. Inclusion criterion was
random allocation to at least two PDT techniques. Exclusion
criteria were duplicate publications, nonadult studies, and
absence of outcome data.
Study Design: Population, clinical setting, and complications
were extracted.
Results: Data from 1130 patients in 13 randomized trials were
analyzed. Multiple dilators, single-step dilatation, guide wire
dilating forceps, rotational dilation, retrograde tracheostomy,
and balloon dilation techniques were always performed in the
intensive care unit. The different techniques and devices
appeared largely equivalent, with the exception of retrograde
tracheostomy, which was associated with more severe complications
and more frequent need of conversion to other techniques
when compared with guide wire dilating forceps and single-step
dilatation techniques. Single-step dilatation technique was associated
with fewer failures than rotational dilation, and fewer
mild complications in comparison with balloon dilation and
guide wire dilating forceps (all P < 0.05).
Conclusions: Among the six analyzed techniques, single-step
dilatation technique appeared the most reliable in terms of safety
and success rate. However, the number of available randomized
trials was insufficient to confidently assess the best PDT
technique.