C. J. Lee1, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2New Jersey Medical School,Newark, NJ, USA 3Saint George’s University,Grenada, Grenada, Grenada
Introduction: Percutaneous tracheostomy (PT) was first described by Toye and Weinstein in 1969, and has gained wide acceptance. Despite being the procedure of choice in many ICUs, ongoing controversy over complication rates has led many surgeons to prefer standard open tracheostomy (ST) versus PT. This meta-analysis assesses all randomized controlled trials (RCTs) comparing PT to ST evaluating operative time and postoperative outcomes to develop evidence based recommendations on tracheostomy method.
Methods: A comprehensive literature search of PubMed, the Cochrane Central Register of Controlled Trials, and Medline was performed. 21 prospective, RCTs were identified comparing PT with ST in adult, intensive care unit patients requiring tracheostomy (1991-2014). Data were extracted on study design, study size, rate of tracheostomy site infection, rate of intraoperative and postoperative hemorrhage, rate of pneumothorax, rate of subcutaneous emphysema, and recorded operative time.
Results: 21 trials involving 2,074 subjects were included in the meta-analysis. Among these 2,074 adult ICU patients, 996 involved PT, and 1,078 were ST. PT techniques included Cook Blue Rhino, Ciaglia and Griggs’ techniques. PT was associated with a 65% decrease in the likelihood of wound infection (risk ratio (RR) 0.35; 95% CI, 0.22 to 0.54, p<0.001) and significantly shorter operative time (Standard difference in means -1.67; 95% CI, -2.25 to -0.99, p<0.001) compared to ST. No significant differences in intraoperative hemorrhage (p=0.675), postoperative hemorrhage (p=0.287), pneumothorax (p=0.528) or subcutaneous emphysema rates were observed (p=0.484).
Conclusion: PT is associated with a significant decrease (65%) in the incidence of wound infection when compared to ST, and is comparable regarding other major operative complications such as hemorrhage, pneumothorax, and subcutaneous emphysema. PT can be performed in a significantly shorter amount of time compared to ST. In the critically ill patient in an intensive care setting, PT can be recommended as the procedure of choice and a safe alternative when an elective tracheostomy is required.
