Chest
Clinical Investigations in Critical CareA Meta-analysis of Prospective Trials Comparing Percutaneous and Surgical Tracheostomy in Critically Ill Patients
Section snippets
Materials and Methods
Using the search term percutaneous tracheostomy, weperformed searches of the MEDLINE, Current Contents, Best Evidence,Cochrane, and HealthSTAR databases from 1985 (the year that PDT wasinitially described4) to present to identify prospectivestudies comparing PDT and SCT. Our search was not restricted toEnglish-language articles. We limited the studies for analysis to thosethat prospectively compared PDT to SCT in populations of critically illpatients requiring prolonged mechanical ventilation.
Study Characteristics
Since 1985, 278 articles have been published on the technique ofPDT. Of these, we identified six prospective studies that compared PDTto SCT.181920212223 We excluded one study from our analysisbecause a large fraction of patients enrolled (60%) were notcritically ill, and were undergoing tracheostomy as part of an electiveprocedure (tumor resection).23 We included the remainingfive studies that enrolled 236 critically ill patients requiringtracheostomy for prolonged mechanical ventilation (115
Discussion
Since its description in 1985, PDT has gained widespreadacceptance as a method for creating an elective surgical airway in thepatient requiring long-term mechanical ventilation.9However, the benefits and risks of this technique, relative toconventional surgical approaches, have been determined largely fromstudies that are observational in design. In fact, our reviewidentified only five small (ranging in enrollment from 24 to 60patients) prospective studies comparing these two techniques
Conclusion
In summary, PDT has gained widespread acceptance despite thelimited number of studies comparing it to conventional surgicaltechnique. Our meta-analysis of prospective studies comparing PDT andSCT in critically ill patients suggests that PDT has some advantagesrelative to SCT, including ease of performance, and lower incidence ofperistomal bleeding and postoperative infection. Whether there is anyadvantage of PDT compared to SCT with respect to either long-termcomplications or cost requires
References (30)
- et al.
Elective percutaneous dilational tracheostomy
Chest
(1985) - et al.
Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure
Surgery
(1995) - et al.
Percutaneous tracheostomy: is it really better?
Chest
(1998) - et al.
Iatrogenic rupture of the tracheobronchial tree
Chest
(1997) - et al.
Comparison of percutaneous and surgical tracheostomies
Chest
(1996) Rules of evidence and clinical recommendations on the use of antithrombotic agents
Chest
(1989)- et al.
Clinical predictors and outcomes for patients requiring tracheostomy in the intensive care unit
Crit Care Med
(1999) Tracheostomy
Chest Surg Clin North Am
(1996)- et al.
- et al.
Percutaneous dilatational tracheostomy in the medical ICU
Intensive Care Med
(1997)