Rajuri Spandan, Kumar Kiran, Rakam Kalyan
Critical Care Medicine, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE.
Critical Care Medicine, Al Dhafra Hospital, Abu Dhabi, ARE.
Cureus. 2025 Mar 17;17(3):e80708. doi: 10.7759/cureus.80708. eCollection 2025 Mar.
Bronchoscopy-guided percutaneous dilatational tracheostomy (BPDT) and ultrasound-guided percutaneous dilatational tracheostomy (USPDT) are widely employed techniques. However, USPDT provides better vascular mapping and reduces bleeding risk, while BPDT offers better tracheal entry and fewer airway complications. Their comparative efficacy and safety were systematically evaluated, with special consideration for high-risk patients, including obese and critically ill individuals with complex airway anatomy. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an in-depth literature search was conducted in Embase, PubMed, Scopus, and Cochrane Library, focusing on adult patients undergoing percutaneous tracheostomy with USPDT, BPDT, or both. Quality assessment indicated that most studies exhibited a low risk of bias, though concerns regarding randomization and selective reporting were noted in some cases. A meta-analysis was conducted using pooled effect sizes, procedural success rates, complication rates, and heterogeneity (I²), applying a random-effects model. Ten studies involving 1,069 patients were analyzed. The pooled analysis demonstrated a moderate positive association between USPDT and BPDT in improving procedural success and reducing complications (CI: 0.41 to 0.55, standardized mean difference = 0.48, 95%, p < 0.05). However, significant heterogeneity (I² = 72.95%) was observed, likely due to variations in study design and patient populations. USPDT and BPDT are both practical and safe for percutaneous tracheostomy, with unique advantages for different clinical scenarios. The findings support a hybrid approach integrating both modalities to enhance procedural safety and efficiency, particularly in high-risk populations. Future large-scale trials should focus on reducing heterogeneity, assessing long-term outcomes, and improving cost-effectiveness to establish best-practice guidelines for broader clinical implementation.
支气管镜引导下经皮扩张气管切开术（BPDT）和超声引导下经皮扩张气管切开术（USPDT）是广泛应用的技术。然而，USPDT能提供更好的血管定位并降低出血风险，而BPDT能提供更好的气管穿刺入口且气道并发症更少。对它们的相对疗效和安全性进行了系统评估，特别考虑了高危患者，包括肥胖和气道解剖结构复杂的重症患者。按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，在Embase、PubMed、Scopus和Cochrane图书馆进行了深入的文献检索，重点关注接受USPDT、BPDT或两者联合的经皮气管切开术的成年患者。质量评估表明，大多数研究显示偏倚风险较低，不过在某些情况下注意到了关于随机化和选择性报告的问题。使用合并效应量、操作成功率、并发症发生率和异质性（I²）进行荟萃分析，应用随机效应模型。分析了涉及1069例患者的10项研究。汇总分析表明，USPDT和BPDT在提高操作成功率和减少并发症方面存在中度正相关（CI：0.41至0.55，标准化均差=0.48，95%，p<0.05）。然而，观察到显著的异质性（I²=72.95%），可能是由于研究设计和患者群体的差异。USPDT和BPDT在经皮气管切开术中都是实用且安全的，在不同临床场景中具有独特优势。研究结果支持采用整合两种方式的混合方法来提高操作安全性和效率，特别是在高危人群中。未来的大规模试验应侧重于减少异质性、评估长期结果和提高成本效益，以建立更广泛临床应用的最佳实践指南。
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