Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis

• Published in: PloS one 2021-10, Vol.16 (10), p.e0258972-e0258972
• Main Authors: Lin, Kun-Te, Kao, Yung-Shuo, Chiu, Chun-Wen, Lin, Chi-Hsien, Chou, Chu-Chung, Hsieh, Pei-You, Lin, Yan-Ren
• Format: Article
• Language: English
• Subjects: Bias; Biology and Life Sciences; Bleeding; Complications; Complications and side effects; Confidence intervals; Critical care; Evaluation; Health risks; Hospitals; Intervention; Literature reviews; Medical instruments; Medicine; Medicine and Health Sciences; Meta-analysis; Methods; Ostomy; Patient outcomes; Patients; Physical Sciences; Placement; Research and Analysis Methods; Success; Tracheostomy; Tracheotomy; Ultrasonic imaging; Ultrasonic waves; Ultrasound; Ventilators
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0258972

Introduction Ultrasound-guided tracheostomy (UGT) and bronchoscope-guided tracheostomy (BGT) have been well compared. However, the differences in benefits between UGT and landmark tracheostomy (LT) have not been addressed and, in particular, lack a detailed meta-analysis. We aimed to compare the first-pass success, complication rate, major bleeding rate, and tracheostomy procedure time between UGT and LT. Methods In a systematic review, relevant databases were searched for studies comparing UGT with LT in intubated patients. The primary outcome was the odds ratio (OR) of first-pass success. The secondary outcomes were the OR of complications, OR of major bleeding, and standardized mean difference (SMD) of the total tracheostomy procedure time. Results The meta-analysis included three randomized controlled studies (RCTs) and one nonrandomized controlled study (NRS), comprising 474 patients in total. Compared with LT, UGT increased first-pass success (OR: 4.287; 95% confidence interval [CI]: 2.308 to 7.964) and decreased complications (OR: 0.422; 95% CI: 0.249 to 0.718). However, compared with LT, UGT did not significantly reduce major bleeding (OR: 0.374; 95% CI: 0.112 to 1.251) or the total tracheostomy placement time (SMD: -0.335; 95% CI: -0.842 to 0.172). Conclusions Compared with LT, real-time UGT increases first-pass success and decreases complications. However, UGT was not associated with a significant reduction in the major bleeding rate. The total tracheostomy placement time comparison between UGI and LT was inconclusive.