title: Percutaneous tracheostomy, a systematic review.
abstract: BACKGROUND
  Percutaneous dilatational tracheostomy (PDT) is a common procedure in intensive care units and the identification of the best technique is very important. We performed a systematic review and meta-analysis of randomized studies comparing different PDT techniques in critically ill adult patients to investigate if one technique is superior to the others with regard to major and minor intraprocedural complications.
  
  
  METHODS
  BioMedCentral and other database of clinical trials were searched for pertinent studies. Inclusion criterion was random allocation to at least two PDT techniques. Exclusion criteria were duplicate publications, nonadult studies, and absence of outcome data.
  
  
  METHODS
  Population, clinical setting, and complications were extracted.
  
  
  RESULTS
  Data from 1130 patients in 13 randomized trials were analyzed. Multiple dilators, single-step dilatation, guide wire dilating forceps, rotational dilation, retrograde tracheostomy, and balloon dilation techniques were always performed in the intensive care unit. The different techniques and devices appeared largely equivalent, with the exception of retrograde tracheostomy, which was associated with more severe complications and more frequent need of conversion to other techniques when compared with guide wire dilating forceps and single-step dilatation techniques. Single-step dilatation technique was associated with fewer failures than rotational dilation, and fewer mild complications in comparison with balloon dilation and guide wire dilating forceps (all P < 0.05).
  
  
  CONCLUSIONS
  Among the six analyzed techniques, single-step dilatation technique appeared the most reliable in terms of safety and success rate. However, the number of available randomized trials was insufficient to confidently assess the best PDT technique.
authors.affiliation: University Vita-Salute San Raffaele, Milano, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cabrini
authors.forename: G
authors.initials: G
authors.lastname: Monti
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.forename: G
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: F
authors.initials: F
authors.lastname: Boroli
authors.forename: D
authors.initials: D
authors.lastname: Mamo
authors.forename: V P
authors.initials: VP
authors.lastname: Plumari
authors.forename: S
authors.initials: S
authors.lastname: Colombo
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000328:Adult; D002404:Catheterization; D016638:Critical Illness; D003627:Data Interpretation, Statistical; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D014139:Tracheostomy / Q000379:methods*; D016896:Treatment Outcome