Effectiveness of ultrasound-guided versus anatomical landmark-guided percutaneous dilatational tracheostomy: a systematic review and meta-analysis.
Systematic Review
Percutaneous dilatational tracheostomy (PDT) is increasingly used in intensive care units owing to its advantages of reduced surgical trauma and fewer complications. Recently, ultrasonography has become a potentially useful tool for assisting PDT./r/nTo compare ultrasound- and landmark-guided PDT for major bleeding, first-puncture success rates, periprocedural complications, and tracheotomy procedure times./r/nRandomized controlled trials (RCTs) or non-RCTs comparing ultrasound- and landmark-guided PDT were searched for in PubMed, Web of Science, MEDLINE, CINAHL, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Service System (SinoMed). The primary outcomes were major bleeding and first puncture success rate. Secondary outcomes were periprocedural complications and the tracheotomy procedure time. The meta-analysis was performed using RevMan 5.3 software./r/nThis meta-analysis included five RCTs and one non-RCT, with a total of 609 patients. Compared with landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding (odds ratio [OR] = 0.35, 95% confidence interval [CI; 0.14, 0.90], P = 0.03) and improved the success rate of first puncture (OR = 4.41, 95% CI [2.54, 7.65], P < 0.000001). Additionally, ultrasound-guided PDT is associated with a lower incidence of periprocedural complications (OR = 0.35, 95% CI [0.22, 0.54], P < 0.00001). However, there was no advantage in reducing the tracheotomy procedure time between the two methods (mean difference = - 0.64, 95% CI [-4.14, 2.85], P = 0.72)./r/nCompared to landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding and periprocedural complications and increase the success rate of the first puncture. However, the advantage of ultrasound-guided PDT in reducing the tracheotomy procedure time is unclear.
