Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, Changhua, Taiwan.
Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
PLoS One. 2021 Oct 28;16(10):e0258972. doi: 10.1371/journal.pone.0258972. eCollection 2021.
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.
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.
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).
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.
超声引导经皮气管切开术（UGT）和支气管镜引导经皮气管切开术（BGT）已得到充分比较。然而，UGT 与体表标志法气管切开术（LT）之间的获益差异尚未得到解决，特别是缺乏详细的荟萃分析。我们旨在比较 UGT 和 LT 之间的首次穿刺成功率、并发症发生率、大出血发生率和气管切开术时间。
在系统评价中，检索了比较经气管插管患者 UGT 与 LT 的相关数据库。主要结局是首次穿刺成功率的比值比（OR）。次要结局是并发症的 OR、大出血的 OR 和总气管切开术时间的标准化均数差（SMD）。
荟萃分析纳入了 3 项随机对照研究（RCT）和 1 项非随机对照研究（NRS），共纳入 474 例患者。与 LT 相比，UGT 增加了首次穿刺成功率（OR：4.287；95%置信区间 [CI]：2.308 至 7.964）和降低了并发症发生率（OR：0.422；95% CI：0.249 至 0.718）。然而，与 LT 相比，UGT 并未显著降低大出血发生率（OR：0.374；95% CI：0.112 至 1.251）或总气管切开术时间（SMD：-0.335；95% CI：-0.842 至 0.172）。
与 LT 相比，实时 UGT 增加了首次穿刺成功率并降低了并发症发生率。然而，UGT 与大出血发生率降低无关。UGT 与 LT 之间的总气管切开术时间比较尚无定论。
