Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials

Area of Science:

• Critical Care Medicine
• Surgical Techniques
• Respiratory Medicine

Background:

• Percutaneous dilatational tracheostomy (PDT) is crucial for critically ill adults.
• Single dilator technique (SDT) and guide wire dilating forceps (GWDF) are common PDT methods.
• Comparing intraoperative and long-term complications of SDT versus GWDF is essential.

Purpose of the Study:

• To compare intraoperative, mid-term, and late complications of SDT and GWDF in PDT.
• To evaluate the safety and efficacy of two leading PDT techniques.

Main Methods:

• A meta-analysis of randomized controlled trials was conducted.
• Studies were searched across major biomedical databases (BioMedCentral, PubMed, Embase, Cochrane).
• Five eligible randomized trials involving 363 adult critically ill patients were analyzed.

Main Results:

• The guide wire dilating forceps (GWDF) technique showed a higher incidence of difficult cannula insertion/dilation or failure (15.5% vs. 4.9%, P=0.02).
• Intraprocedural bleeding was significantly more frequent with GWDF (19.3% vs. 7.6%, P=0.018).
• A trend towards increased tracheal ring fractures was observed with SDT (6.5% vs. 0.5%, P=0.13), with no significant mid- or long-term complication differences.

Conclusions:

• The GWDF technique is associated with increased intraprocedural bleeding and technical difficulties compared to SDT.
• No significant differences in mid-term or long-term complications were identified between the two techniques.
• Further research is needed to compare SDT and GWDF in diverse patient populations, including high-risk subgroups.