Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis

Anthony Delaney, Sean M Bagshaw, Marek Nalos, Anthony Delaney, Sean M Bagshaw, Marek Nalos

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.

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.
    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.
    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.
    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.
    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.
    1. Nieszkowska A, Combes A, Luyt CE, Ksibi H, Trouillet JL, Gibert C, Chastre J. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med. 2005;33:2527–2533. doi: 10.1097/01.CCM.0000186898.58709.AA.
    1. McWhorter AJ. Tracheotomy: timing and techniques. Curr Opin Otolaryngol Head Neck Surg. 2003;11:473–479.
    1. Shelden C, Pudenz R. Percutaneous tracheotomy. J Am Med Assoc. 1957;165:2068–2070.
    1. Ciaglia P, Firsching R, Syniec C. Elective percutaneous dilatational tracheostomy. A new simple bedside procedure; preliminary report. Chest. 1985;87:715–719.
    1. Al-Ansari MA, Hijazi MH. Clinical review: Percutaneous dilatational tracheostomy. Crit Care. 2005;10:202. doi: 10.1186/cc3900.
    1. Blot F, Melot C. Indications, timing, and techniques of tracheostomy in 152 French ICUs. Chest. 2005;127:1347–1352. doi: 10.1378/chest.127.4.1347.
    1. Fikkers BG, Fransen GA, van der Hoeven JG, Briede IS, van den Hoogen FJ. Tracheostomy for long-term ventilated patients: a postal survey of ICU practice in The Netherlands. Intensive Care Med. 2003;29:1390–1393. doi: 10.1007/s00134-003-1824-x.
    1. Fischler L, Erhart S, Kleger GR, Frutiger A. Prevalence of tracheostomy in ICU patients. A nation-wide survey in Switzerland. Intensive Care Med. 2000;26:1428–1433. doi: 10.1007/s001340000634.
    1. Krishnan K, Elliot SC, Mallick A. The current practice of tracheostomy in the United Kingdom: a postal survey. Anaesthesia. 2005;60:360–364. doi: 10.1111/j.1365-2044.2004.04106.x.
    1. Dulguerov P, Gysin C, Perneger TV, Chevrolet JC. Percutaneous or surgical tracheostomy: a meta-analysis. Crit Care Med. 1999;27:1617–1625. doi: 10.1097/00003246-199908000-00041.
    1. Cheng E, Fee WE., Jr Dilatational versus standard tracheostomy: a meta-analysis. Ann Otol Rhinol Laryngol. 2000;109:803–807.
    1. Freeman BD, Isabella K, Lin N, Buchman TG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest. 2000;118:1412–1418. doi: 10.1378/chest.118.5.1412.
    1. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of Reporting of Meta-analyses. Lancet. 1999;354:1896–1900. doi: 10.1016/S0140-6736(99)04149-5.
    1. Haynes RB, Wilczynski N, McKibbon KA, Walker CJ, Sinclair JC. Developing optimal search strategies for detecting clinically sound studies in MEDLINE. J Am Med Inform Assoc. 1994;1:447–458.
    1. Dickersin K, Scherer R, Lefebvre C. Identifying relevant studies for systematic reviews. BMJ. 1994;309:1286–1291.
    1. Jong Joon A, Koh Y, Jae Yong C, Ki Man L, Park W, Hong SB, Tae Sun S, Sang Do L, Woo Sung K, Kim DS, et al. Comparison of clinical efficacy between percutaneous dilatational tracheostomy and surgical tracheostomy. Tuberculosis Respiratory Dis. 1998;45:1277–1283.
    1. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273:408–412. doi: 10.1001/jama.273.5.408.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
    1. Antonelli M, Michetti V, Di Palma A, Conti G, Pennisi MA, Arcangeli A, Montini L, Bocci MG, Bello G, Almadori G, et al. Percutaneous translaryngeal versus surgical tracheostomy: A randomized trial with 1-yr double-blind follow-up. Crit Care Med. 2005;33:1015–1020. doi: 10.1097/01.CCM.0000163401.77581.86.
    1. Crofts SL, Alzeer A, McGuire GP, Wong DT, Charles D. A comparison of percutaneous and operative tracheostomies in intensive care patients. Can J Anaesth. 1995;42:775–779.
    1. Freeman BD, Isabella K, Cobb JP, Boyle WA, 3rd, Schmieg RE, Jr, Kolleff MH, Lin N, Saak T, Thompson EC, Buchman TG. A prospective, randomized study comparing percutaneous with surgical tracheostomy in critically ill patients. Crit Care Med. 2001;29:926–930. doi: 10.1097/00003246-200105000-00002.
    1. Friedman Y, Fildes J, Mizock B, Samuel J, Patel S, Appavu S, Roberts R. Comparison of percutaneous and surgical tracheostomies. Chest. 1996;110:480–485.
    1. Gysin C, Dulguerov P, Guyot JP, Perneger TV, Abajo B, Chevrolet JC. Percutaneous versus surgical tracheostomy: a double-blind randomized trial. Ann Surg. 1999;230:708–714. doi: 10.1097/00000658-199911000-00014.
    1. Hazard P, Jones C, Benitone J. Comparative clinical trial of standard operative tracheostomy with percutaneous tracheostomy. Crit Care Med. 1991;19:1018–1024.
    1. Heikkinen M, Aarnio P, Hannukainen J. Percutaneous dilational tracheostomy or conventional surgical tracheostomy? Crit Care Med. 2000;28:1399–1402. doi: 10.1097/00003246-200005000-00023.
    1. Holdgaard HO, Pedersen J, Jensen RH, Outzen KE, Midtgaard T, Johansen LV, Moller J, Paaske PB. Percutaneous dilatational tracheostomy versus conventional surgical tracheostomy. A clinical randomised study. Acta Anaesthesiologica Scandinavica. 1998;42:545–550.
    1. Melloni G, Muttini S, Gallioli G, Carretta A, Cozzi S, Gemma M, Zannini P. Surgical tracheostomy versus percutaneous dilatational tracheostomy. A prospective-randomized study with long-term follow-up. J Cardiovasc Surg. 2002;43(Torino):113–121.
    1. Porter JM, Ivatury RR. Preferred route of tracheostomy--percutaneous versus open at the bedside: a randomized, prospective study in the surgical intensive care unit. Am Surg. 1999;65:142–146.
    1. Raine R, Michell WL, Ruttmann TG, Bloch MB, Thorp M, Gough AM. Late outcome after guide-wire forceps percutaneous tracheostomy – a prospective, randomised comparison with open surgical tracheostomy [abstract] Br J Anaesth. 1999;82(Suppl 1):168.
    1. Sustic A, Krstulovic B, Eskinja N, Zelic M, Ledic D, Turina D. Surgical tracheostomy versus percutaneous dilational tracheostomy in patients with anterior cervical spine fixation: preliminary report. Spine. 2002;27:1942–1945. doi: 10.1097/00007632-200209010-00026.
    1. Tabaee A, Geng E, Lin J, Kakoullis S, McDonald B, Rodriguez H, Chong D. Impact of neck length on the safety of percutaneous and surgical tracheotomy: a prospective, randomized study. Laryngoscope. 2005;115:1685–1690. doi: 10.1097/01.MLG.0000175539.25182.2A.
    1. Wu JJ, Huang MS, Tang GJ, Shih SC, Yang CC, Kao WF, Huang MH, Lee CH. Percutaneous dilatational tracheostomy versus open tracheostomy – a prospective, randomized, controlled trial. J Chin Med Assoc. 2003;66:467–473.
    1. Silvester W, Goldsmith D, Uchino S, Bellomo R, Knight S, Seevanayagam S, Brazzale D, McMahon M, Buckmaster J, Hart G, et al. Percutaneous versus surgical tracheostomy: a randomised controlled study with long-term follow-up. Crit Care Med.
    1. Massick DD, Yao S, Powell DM, Griesen D, Hobgood T, Allen JN, Schuller DE. Bedside tracheostomy in the intensive care unit: a prospective randomized trial comparing open surgical tracheostomy with endoscopically guided percutaneous dilational tracheotomy. Laryngoscope. 2001;111:494–500. doi: 10.1097/00005537-200103000-00021.
    1. Targarona EM, Balague C, Knook MM, Trias M. Laparoscopic surgery and surgical infection. Br J Surg. 2000;87:536–544. doi: 10.1046/j.1365-2168.2000.01429.x.
    1. Iwanaka T, Arkovitz MS, Arya G, Ziegler MM. Evaluation of operative stress and peritoneal macrophage function in minimally invasive operations. J Am Coll Surg. 1997;184:357–363.
    1. Warren J, Fromm RE, Jr, Orr RA, Rotello LC, Horst HM. Guidelines for the inter- and intrahospital transport of critically ill patients. Crit Care Med. 2004;32:256–262. doi: 10.1097/01.CCM.0000104917.39204.0A.
    1. Waydhas C. Intrahospital transport of critically ill patients. Crit Care. 1999;3:R83–89. doi: 10.1186/cc362.
    1. Beckmann U, Gillies DM, Berenholtz SM, Wu AW, Pronovost P. Incidents relating to the intra-hospital transfer of critically ill patients. An analysis of the reports submitted to the Australian Incident Monitoring Study in Intensive Care. Intensive Care Med. 2004;30:1579–1585. doi: 10.1007/s00134-004-2177-9.
    1. Lovell MA, Mudaliar MY, Klineberg PL. Intrahospital transport of critically ill patients: complications and difficulties. Anaesth Intensive Care. 2001;29:400–405.
    1. Arabi Y, Haddad S, Shirawi N, Al Shimemeri A. Early tracheostomy in intensive care trauma patients improves resource utilization: a cohort study and literature review. Crit Care. 2004;8:R347–352. doi: 10.1186/cc2924.
    1. Rumbak MJ, Newton M, Truncale T, Schwartz SW, Adams JW, Hazard PB. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit Care Med. 2004;32:1689–1694. doi: 10.1097/01.CCM.0000134835.05161.B6.
    1. Shirawi N, Arabi Y. Bench-to-bedside review: Early tracheostomy in critically ill trauma patients. Crit Care. 2005;10:201. doi: 10.1186/cc3828.
    1. Walz MK, Peitgen K, Thurauf N, Trost HA, Wolfhard U, Sander A, Ahmadi C, Eigler FW. Percutaneous dilatational tracheostomy – early results and long-term outcome of 326 critically ill patients. Intensive Care Med. 1998;24:685–690. doi: 10.1007/s001340050645.
    1. Dollner R, Verch M, Schweiger P, Deluigi C, Graf B, Wallner F. Laryngotracheoscopic findings in long-term follow-up after Griggs tracheostomy. Chest. 2002;122:206–212. doi: 10.1378/chest.122.1.206.
    1. Norwood S, Vallina VL, Short K, Saigusa M, Fernandez LG, McLarty JW. Incidence of tracheal stenosis and other late complications after percutaneous tracheostomy. Ann Surg. 2000;232:233–241. doi: 10.1097/00000658-200008000-00014.
    1. Nates NL, Cooper DJ, Myles PS, Scheinkestel CD, Tuxen DV. Percutaneous tracheostomy in critically ill patients: a prospective, randomized comparison of two techniques. Crit Care Med. 2000;28:3734–3739. doi: 10.1097/00003246-200011000-00034.
    1. Ambesh SP, Pandey CK, Srivastava S, Agarwal A, Singh DK. Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia blue rhino versus Griggs' guidewire dilating forceps. Anesth Analg. 2002;95:1739–1745. doi: 10.1097/00000539-200212000-00050.
    1. Byhahn C, Wilke HJ, Lischke V, Rinne T, Westphal K. Bedside percutaneous tracheostomy: clinical comparison of Griggs and Fantoni techniques. World J Surg. 2001;25:296–301. doi: 10.1007/s002680020087.
    1. Westphal K, Byhahn C, Wilke HJ, Lischke V. Percutaneous tracheostomy: a clinical comparison of dilatational (Ciaglia) and translaryngeal (Fantoni) techniques. Anesth Analg. 1999;89:938–943. doi: 10.1097/00000539-199910000-00022.
    1. Oberwalder M, Weis H, Nehoda H, Kafka-Ritsch R, Bonatti H, Prommegger R, Aigner F, Profanter C. Videobronchoscopic guidance makes percutaneous dilational tracheostomy safer. Surg Endosc. 2004;18:839–842.
    1. Ben Nun A, Altman E, Best LA. Extended indications for percutaneous tracheostomy. Ann Thorac Surg. 2005;80:1276–1279. doi: 10.1016/j.athoracsur.2005.02.007.

Source: PubMed

Sponsorer og samarbejdspartnere

Medicinske tilstande

Narkotikainterventioner

3
Abonner