National Center for Biotechnology Information , U. Journal List Crit Care v. Crit Care. Published online Apr 7. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Anthony Delaney: ua. This article has been cited by other articles in PMC. 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.
Results Seventeen RCTs involving 1, patients were included. 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. Introduction Tracheostomy, an ancient surgical procedure originally described in the first century BC [ 1 ], is one of the more commonly performed procedures in modern intensive care, and is predicted to become more common as demand for intensive care services increases [ 2 , 3 ].
Materials and methods Search strategy Randomized clinical trials RCTs comparing PDT with ST in critically ill patients were identified using both electronic and manual search strategies supplemented by scanning the bibliographies of all retrieved articles as well as review articles, and reviewing selected conference proceedings American Thoracic Society to , Society of Critical Care Medicine to , European Society of Intensive Care Medicine to and American College of Chest Physicians to Study selection An initial screen of all titles and abstracts was conducted to confirm the report was of a trial comparing methods of performing tracheostomies in critically ill patients.
Validity assessment The validity of the included studies was assessed using a priori defined criteria. Data abstraction Data were abstracted onto standardized data collection forms by two authors SB and AD , independently, with disagreements resolved by discussion.
Quantitative data synthesis Agreement on the inclusion of studies was assessed with the Kappa statistic. Results Study selection Database searches generated a total of 1, references. Open in a separate window. Figure 1. Study description A total of 1, participants were randomized in the 17 RCTs. Table 1 Characteristics of randomized clinical trials comparing percutaneous dilatational and surgical tracheostomy in critically ill patients.
Study No. Table 2 Summary of validity assessments for RCTs comparing percutaneous dilatational and surgical tracheostomy in critically ill patients. Table 3 Summary of long-term complications comparing percutaneous dilatational and surgical tracheostomy in critically ill patients. Evidence synthesis Wound infection Clinically important wound infection was diagnosed in 6. Figure 2. Bleeding The overall incidence of clinically relevant bleeding was 5.
Figure 3. Figure 4. Other short-term outcomes Other major complications occurred in 2. Effect of study quality on major outcomes Only two RCTs attempted to perform blinding for the adjudication of the presence of wound infection. Table 4 Sensitivity analysis for primary outcomes comparing percutaneous dilatational and surgical tracheostomy in critically ill patients.
Outcome Subgroup No. Discussion This systematic review and meta-analysis has demonstrated that the technique of PDT has a number of important advantages over performing a ST in critically ill patients who require an elective tracheostomy. Conclusion We have demonstrated that use of PDT is associated with a reduced incidence of wound infection compared to ST in critically ill patients.
Competing interests The authors declare that they have no competing interests. Authors' contributions AD conceived the study, developed the study protocol, conducted the study search, selected studies, abstracted data, analyzed data, and wrote and revised the manuscript. Click here for file 66K, doc. Click here for file 31K, doc. Click here for file 25K, doc. Additional File 6: Forest plot showing the comparison of PDT and ST on the duration of translaryngeal intubation prior to tracheostomy.
Click here for file 28K, doc. Techniques of surgical tracheostomy. Clin Chest Med. Increase in tracheostomy for prolonged mechanical ventilation in North Carolina, — Crit Care Med.
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A clinical randomised study. Acta Anaesthesiologica Scandinavica. Surgical tracheostomy versus percutaneous dilatational tracheostomy. Most studies were rated as having a moderate risk of bias. Among patients, flexible visiting policies were associated with reduced frequency of delirium odds ratio, 0. Flexible visiting policies were not associated with increased risk of ICU mortality odds ratio, 0.
Among family members, flexible visiting policies were associated with greater satisfaction. Among ICU professionals, flexible visiting policies were associated with higher burnout levels.
Meta-analysis of the outcome of mortality from controlled trials of ivermectin treatment in COVID Small diamond indicates sum effect of all trial designs. Meta-analysis of the outcome of time to clinical recovery from controlled trials of ivermectin treatment in COVID CI, confidence interval. The authors have no conflicts of interest to declare. National Center for Biotechnology Information , U. Am J Ther. Published online Sep 2. Paul E. Author information Copyright and License information Disclaimer.
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