Comparing Tracheostomy Methods in Critically Ill Patients
Author Information
Author(s): Delaney Anthony, Bagshaw Sean M, Nalos Marek
Primary Institution: Royal North Shore Hospital, Sydney, NSW, Australia
Hypothesis
Is percutaneous dilatational tracheostomy (PDT) superior to surgical tracheostomy (ST) in critically ill patients?
Conclusion
PDT reduces the overall incidence of wound infection and may further reduce clinically relevant bleeding and mortality compared to ST performed in the operating theatre.
Supporting Evidence
- PDT was associated with a significant reduction in wound infection compared to ST.
- There was no overall increase in clinically significant bleeding with PDT.
- PDT showed a trend towards lower mortality when compared to ST performed in the operating theatre.
- PDT can be performed at the bedside in the ICU, reducing transport risks for critically ill patients.
Takeaway
Doctors compared two ways to do tracheostomy in very sick patients. They found that one way, called PDT, is better because it causes fewer infections.
Methodology
A systematic review and meta-analysis of randomized clinical trials comparing PDT and ST in critically ill adults.
Potential Biases
Only two studies used blinding for outcome assessment, and less than half maintained allocation concealment.
Limitations
The generalizability of results is limited due to exclusion of certain patient groups and variability in outcome definitions across studies.
Participant Demographics
Adult critically ill patients requiring elective tracheostomy.
Statistical Information
P-Value
p<0.0005
Confidence Interval
0.16 to 0.49
Statistical Significance
p<0.0005
Digital Object Identifier (DOI)
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