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Background <p>Percutaneous dilatational tracheostomy (PDT) is increasingly used in intensive care units owing to its advantages of reduced surgical trauma and fewer complications. Recently, ultrasonography has become a potentially useful tool for assisting PDT.</p> Objective <p>To compare ultrasound- and landmark-guided PDT for major bleeding, first-puncture success rates, periprocedural complications, and tracheotomy procedure times.</p> Methods <p>Randomized controlled trials (RCTs) or non-RCTs comparing ultrasound- and landmark-guided PDT were searched for in PubMed, Web of Science, MEDLINE, CINAHL, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Service System (SinoMed). The primary outcomes were major bleeding and first puncture success rate. Secondary outcomes were periprocedural complications and the tracheotomy procedure time. The meta-analysis was performed using RevMan 5.3 software.</p> Results <p>This meta-analysis included five RCTs and one non-RCT, with a total of 609 patients. Compared with landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding (odds ratio [OR] = 0.35, 95% confidence interval [CI; 0.14, 0.90], <i>P</i> = 0.03) and improved the success rate of first puncture (OR = 4.41, 95% CI [2.54, 7.65], <i>P</i> &lt; 0.000001). Additionally, ultrasound-guided PDT is associated with a lower incidence of periprocedural complications (OR = 0.35, 95% CI [0.22, 0.54], <i>P</i> &lt; 0.00001). However, there was no advantage in reducing the tracheotomy procedure time between the two methods (mean difference = − 0.64, 95% CI [–4.14, 2.85], <i>P</i> = 0.72).</p> Conclusion <p>Compared to landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding and periprocedural complications and increase the success rate of the first puncture. However, the advantage of ultrasound-guided PDT in reducing the tracheotomy procedure time is unclear.</p>

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Effectiveness of ultrasound-guided versus anatomical landmark-guided percutaneous dilatational tracheostomy: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年4月25日

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  • Dan Wen,
  • Xiuru Yang,
  • Zhenghua Liang,
  • Yang Hu,
  • Simei Wang,
  • Dan Zhang,
  • Yao Wang,
  • Yuqi Shen,
  • Fenglin Yan

摘要

Background

Percutaneous dilatational tracheostomy (PDT) is increasingly used in intensive care units owing to its advantages of reduced surgical trauma and fewer complications. Recently, ultrasonography has become a potentially useful tool for assisting PDT.

Objective

To compare ultrasound- and landmark-guided PDT for major bleeding, first-puncture success rates, periprocedural complications, and tracheotomy procedure times.

Methods

Randomized controlled trials (RCTs) or non-RCTs comparing ultrasound- and landmark-guided PDT were searched for in PubMed, Web of Science, MEDLINE, CINAHL, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Service System (SinoMed). The primary outcomes were major bleeding and first puncture success rate. Secondary outcomes were periprocedural complications and the tracheotomy procedure time. The meta-analysis was performed using RevMan 5.3 software.

Results

This meta-analysis included five RCTs and one non-RCT, with a total of 609 patients. Compared with landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding (odds ratio [OR] = 0.35, 95% confidence interval [CI; 0.14, 0.90], P = 0.03) and improved the success rate of first puncture (OR = 4.41, 95% CI [2.54, 7.65], P < 0.000001). Additionally, ultrasound-guided PDT is associated with a lower incidence of periprocedural complications (OR = 0.35, 95% CI [0.22, 0.54], P < 0.00001). However, there was no advantage in reducing the tracheotomy procedure time between the two methods (mean difference = − 0.64, 95% CI [–4.14, 2.85], P = 0.72).

Conclusion

Compared to landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding and periprocedural complications and increase the success rate of the first puncture. However, the advantage of ultrasound-guided PDT in reducing the tracheotomy procedure time is unclear.