title: Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials.
abstract: 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, PubMed, Embase and the Cochrane Central Register 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Cabrini
authors.forename: G
authors.initials: G
authors.lastname: Landoni
authors.forename: M
authors.initials: M
authors.lastname: Greco
authors.forename: R
authors.initials: R
authors.lastname: Costagliola
authors.forename: G
authors.initials: G
authors.lastname: Monti
authors.forename: S
authors.initials: S
authors.lastname: Colombo
authors.forename: T
authors.initials: T
authors.lastname: Greco
authors.forename: L
authors.initials: L
authors.lastname: Pasin
authors.forename: G
authors.initials: G
authors.lastname: Borghi
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical; D016638:Critical Illness; D003627:Data Interpretation, Statistical; D006801:Humans; D007432:Intraoperative Period; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D015203:Reproducibility of Results; D013525:Surgical Instruments; D014139:Tracheostomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*