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Meta-Analysis
. 2021 Oct 28;16(10):e0258972.
doi: 10.1371/journal.pone.0258972. eCollection 2021.

Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis

Kun-Te Lin  1 , Yung-Shuo Kao  2 , Chun-Wen Chiu  1   3   4 , Chi-Hsien Lin  1 , Chu-Chung Chou  1   5   6   7 , Pei-You Hsieh  1 , Yan-Ren Lin  1   5   6   7
Affiliations
Meta-Analysis

Comparative effectiveness of ultrasound-guided and anatomic landmark percutaneous dilatational tracheostomy: A systematic review and meta-analysis

Kun-Te Lin et al. PLoS One. .

Abstract

Introduction: Ultrasound-guided tracheostomy (UGT) and bronchoscope-guided tracheostomy (BGT) have been well compared. However, the differences in benefits between UGT and landmark tracheostomy (LT) have not been addressed and, in particular, lack a detailed meta-analysis. We aimed to compare the first-pass success, complication rate, major bleeding rate, and tracheostomy procedure time between UGT and LT.

Methods: In a systematic review, relevant databases were searched for studies comparing UGT with LT in intubated patients. The primary outcome was the odds ratio (OR) of first-pass success. The secondary outcomes were the OR of complications, OR of major bleeding, and standardized mean difference (SMD) of the total tracheostomy procedure time.

Results: The meta-analysis included three randomized controlled studies (RCTs) and one nonrandomized controlled study (NRS), comprising 474 patients in total. Compared with LT, UGT increased first-pass success (OR: 4.287; 95% confidence interval [CI]: 2.308 to 7.964) and decreased complications (OR: 0.422; 95% CI: 0.249 to 0.718). However, compared with LT, UGT did not significantly reduce major bleeding (OR: 0.374; 95% CI: 0.112 to 1.251) or the total tracheostomy placement time (SMD: -0.335; 95% CI: -0.842 to 0.172).

Conclusions: Compared with LT, real-time UGT increases first-pass success and decreases complications. However, UGT was not associated with a significant reduction in the major bleeding rate. The total tracheostomy placement time comparison between UGI and LT was inconclusive.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Inclusion process for the identified studies.
Fig 2
Fig 2. Risks of bias summary.
Fig 3
Fig 3. Forest plot comparing real-time UGT with LT for first-pass success (a) and complications (b).
Fig 4
Fig 4. Forest plot comparing real-time UGT with LT for major bleeding (a) and total tracheostomy procedure time (b).
Fig 5
Fig 5. Funnel plots of first-pass success (a), complications (b), and major bleeding (c).
See this image and copyright information in PMC

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