title: Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients: a systematic review.
abstract: OBJECTIVE
  A systematic review to examine the safety and efficacy of ultrasound before and/or during percutaneous dilatational tracheostomy (PDT).
  
  
  METHODS
  Systematic searches of MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were undertaken to identify trials reporting on safety and efficacy of using ultrasound guidance before and/or during PDT.
  
  
  RESULTS
  Ultrasound before PDT: no controlled trials; two observational studies suggested a possible benefit in avoiding serious complications by identifying vulnerable vascular structures. Real-time ultrasound during PDT: one controlled study, which retrospectively compared real-time ultrasound guidance with the landmark-guided technique and found it to be superior in avoiding cranial misplacement; it appeared to be safe and effective in two observational studies.
  
  
  CONCLUSIONS
  There are currently no randomised controlled trials to establish the safety or efficacy of preprocedural and/or real-time intraprocedural ultrasound guidance during PDT compared with the current standard of care. One study supports the use of real-time ultrasound guidance during PDT in preventing cranial tracheostomy tube misplacement. Observational data suggest that preprocedural ultrasound may help prevent vascular complications and that real-time ultrasound guidance during PDT is likely safe, with a high success rate. A prospective randomised controlled trial evaluating its safety and efficacy compared with the traditional landmarkguided technique is required to establish its role in clinical practice.
authors.affiliation: Department of Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia. rudasdoc@yahoo.com
authors.forename: Máté
authors.initials: M
authors.lastname: Rudas
authors.forename: Ian
authors.initials: I
authors.lastname: Seppelt
mesh_terms: D000328:Adult; D006801:Humans; D012449:Safety; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000009:adverse effects / Q000379:methods