The aim of this study was to assess the different methods of percutaneous tracheostomy in terms of successful performance of the tracheostomy as well as safety. Tracheostomy is the most common procedure performed on the airway for patients in ICUs. Lately, several methods of percutaneous tracheostomy (multiple dilator, progressive dilator, forceps dilation, screw-like dilation, balloon dilation, and translaryngeal) have been described, with theoretical advantages, but there is no consensus about which is better.
METHODS:
A systematic review with critical appraisal of the literature was done. Literature in multiple databases was searched. Randomized controlled trials comparing different tracheostomy methods were selected. Clinical and methodological characteristics were assessed. A meta-analysis using fixed effect models was planned for statistically homogeneous outcomes.
RESULTS:
Fourteen randomized controlled trials were included, most of them with small sample sizes and with comparisons of multiple methods. Blue Rhino methods were less difficult for surgeons (risk difference of 14.7% [95% CI 8–21.5]) and had more minor bleeding events (risk difference of −6.3% [95% CI −13.58 to 0.8]). There were no differences in major bleeding events. Statistically, heterogeneity and lack of data impede comparison with other outcomes.
CONCLUSIONS:
The Blue Rhino method is less difficult and has more minor bleeding events, but physicians also have more experience with this technique. However, trials are underpowered to define the best method.
FrovaG, QuintelM. A new simple method for percutaneous tracheostomy: controlled rotating dilation. A preliminary report. Intensive Care Med, 2002; 28(3):299–303.
6.
ZgodaMA, BergerR. Balloon-facilitated percutaneous dilational tracheostomy tube placement: preliminary report of a novel technique. Chest, 2005; 128(5):3688–3690.
7.
CianchiG, ZagliG, BonizzoliM, BatacchiS, CammelliR, BiondiS, et al. Comparison between single-step and balloon dilatational tracheostomy in intensive care unit: a single-centre, randomized controlled study. Br J Anaesth, 2010; 104(6):728–732.
8.
FantoniA, RipamontiD. A non-derivative, non-surgical tracheostomy: the translaryngeal method. Intensive Care Med, 1997; 23(4):386–392.
9.
CabriniL, MontiG, LandoniG, Biondi-ZoccaiG, BoroliF, MamoD, et al. Percutaneous tracheostomy, a systematic review. Acta Anaesthesiol Scand, 2012; 56(3):270–281.
10.
ByhahnC, WestphalK, MeiningerD, GürkeB, KesslerP, LischkeV. Single-dilator percutaneous tracheostomy: a comparison of PercuTwist and Ciaglia Blue Rhino techniques. Intensive Care Med, 2002; 28(9):1262–1266.
11.
AmbeshSP, PandeyCK, SrivastavaS, AgarwalA, SinghDK. Percutaneous tracheostomy with single dilatation technique: a prospective, randomized comparison of Ciaglia Blue Rhino versus Griggs' guidewire dilating forceps. Anesth Analg, 2002; 95(6):1739–1745.
12.
AñonJM, EscuelaMP, GómezV, MorenoA, LópezJ, DíazR, et al. Percutaneous tracheostomy: Ciaglia Blue Rhino versus Griggs' guide wire dilating forceps. A prospective randomized trial. Acta Anaesthesiol Scand, 2004; 48(4):451–456.
13.
KumarM, TrikhaA, Chandralekha. Percutaneous dilatational tracheostomy: Griggs guide wire dilating forceps technique versus ULTRA-perc single-stage dilator–a prospective randomized study. Indian J Crit Care Med, 2012; 16(2):87–92.
14.
KarvandianK, YousefianM, KhanZH, BaigmohammadiT, ShabaniS. Comparative clinical trial between Ciaglia and Griggs techniques during tracheostomy performed in patients admitted to intensive care unit. Acta Med Iran, 2012; 50(8):525–529.
15.
StocchettiN, ParmaA, LampertiM, SongaV, TogniniL. Neurophysiological consequences of three tracheostomy techniques: a randomized study in neurosurgical patients. J Neurosurg Anesthesiol, 2000; 12(4):307–313.
16.
Van HeurnLW, MastboomWB, ScheerenCI, BrinkPR, RamsayG. Comparative clinical trial of progressive dilatational and forceps dilatational tracheostomy. Intensive Care Med, 2001; 27(1):292–295.
17.
CantaisE, KaiserE, Le-GoffY, PalmierB. Percutaneous tracheostomy: prospective comparison of the translaryngeal technique versus the forceps-dilational technique in 100 critically ill adults. Crit Care Med, 2002; 30(4):815–819.
18.
NatesJL, CooperDJ, MylesPS, ScheinkestelCD, TuxenDV. Percutaneous tracheostomy in critically ill patients: a prospective, randomized comparison of two techniques. Crit Care Med, 2000; 28(11):3734–3739.
19.
MontcriolA, BordesJ, AsencioY, PrunetB, LacroixG, MeaudreE. Bedside percutaneous tracheostomy: a prospective randomised comparison of PercuTwist versus Griggs' forceps dilational tracheostomy. Anaesth Intensive Care, 2011; 39(2):209–216.
20.
KaiserE, CantaisE, GoutorbeP, SalinierL, PalmierB. Prospective randomized comparison of progressive dilational vs forceps dilational percutaneous tracheostomy. Anaesth Intensive Care, 2006; 34(1):51–54.
21.
JohnsonJL, CheathamML, SagravesSG, BlockEF, NelsonLD. Percutaneous dilational tracheostomy: a comparison of single- versus multiple-dilator techniques. Crit Care Med, 2001; 29(6):1251–1254.
22.
ByhahnC, WilkeHJ, HalbigS, LischkeV, WestphalK. Percutaneous tracheostomy: Ciaglia Blue Rhino versus the basic Ciaglia technique of percutaneous dilational tracheostomy. Anesth Analg, 2000; 91(4):882–886.
23.
YurtsevenN, AydemirB, KaracaP, AksoyT, KomurcuG, KurtM, et al. PercuTwist: a new alternative to Griggs and Ciaglia's techniques. Eur J Anaesthesiol, 2007; 24(6):492–497.
24.
BirbicerH, DorukN, YapiciD, AticiS, AltunkanAA, EpozdemirS, OralU. Percutaneous tracheostomy: a comparison of PercuTwist and multi-dilatators techniques. Ann Card Anaesth, 2008; 11(2):131.
SheldenCH, PudenzRH, FreshwaterDB, CrueBL. A new method for tracheotomy. J Neurosurg, 1955; 12(4):428–431.
27.
ChengE, FeeWEJr. Dilatational versus standard tracheostomy: a meta-analysis. Ann Otol Rhinol Laryngol, 2000; 109(9):803–807.
28.
DelaneyA, BagshawSM, NalosM. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis. Crit Care, 2006; 10(2):R55.
29.
FreemanBD, IsabellaK, LinN, BuchmanTG. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest, 2000; 118(5):1412–1418.
30.
HigginsKM, PunthakeeX. Meta-analysis comparison of open versus percutaneous tracheostomy. Laryngoscope, 2007; 117(3):447–454.
31.
GoemanJJ, SolariA, StijnenT. Three-sided hypothesis testing: simultaneous testing of superiority, equivalence and inferiority. Stat Med, 2010; 29(20):2117–2125.
32.
LesaffreE. Superiority, equivalence, and non-inferiority trials. Bull NYU Hosp Jt Dis, 2008; 66(2):150–154.
