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Single dilator vs. guide wire dilating forceps tracheostomy: a meta‐analysis of randomised trials
Author(s) -
CABRINI L.,
LANDONI G.,
GRECO M.,
COSTAGLIOLA R.,
MONTI G.,
COLOMBO S.,
GRECO T.,
PASIN L.,
BORGHI G.,
ZANGRILLO A.
Publication year - 2014
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.12213
Subject(s) - medicine , dilator , forceps , cannula , percutaneous , surgery , meta analysis , randomized controlled trial , incidence (geometry) , physics , optics
Background Single dilator technique ( SDT ) and guide wire dilating forceps ( GWDF ) are the two most commonly used techniques of percutaneous dilatational tracheostomy ( PDT ) in critically ill adult patients. We performed a meta‐analysis of randomised, controlled trials comparing intraoperative, mid‐term and late complications of these two techniques. Methods Pertinent studies were searched in BioMedCentral , PubMe d, E mbase and the C ochrane C entral R egister of clinical trials. We selected all randomised studies comparing SDT and GWDF techniques in adult critically ill patients published in a peer‐reviewed journal. Results Among 1040 retrieved studies, five eligible studies randomising 363 patients (181 to GWDF , 182 to SDT ) were identified. The incidence of the composite outcome difficult cannula insertion/difficult dilation or failure was higher with the GWDF technique (15.5% vs. 4.9 %, P = 0.02). Moreover, intraprocedural bleeding was more common in the GWDF group (19.3% vs. 7.6% in SDT group, P = 0.018). A trend towards an increased incidence of fracture of tracheal rings was noted in the SDT group (6.5% vs. 0.5% in the GWDF group, P = 0.13). No difference in mid‐term or long‐term complications was observed. Conclusion GWDF technique is associated with a higher incidence of intraprocedural bleeding and of technical difficulties in completing the procedure (difficult cannula insertions/difficult dilations or failures) compared with the SDT technique. No differences were identified in mid‐term and long‐term complications. Further studies comparing SDT and GWDF in the general population and in subgroups of high‐risk patients (like obese or hypoxaemic patients) are warranted.