Effectiveness of ultrasound-guided versus anatomical landmark-guided percutaneous dilatational tracheostomy: a systematic review and meta-analysis

被引：0
作者：
Dan Wen [1 ]
Xiuru Yang [1 ]
Zhenghua Liang [1 ]
Yang Hu [1 ]
Simei Wang [1 ]
Dan Zhang [1 ]
Yao Wang [1 ]
Yuqi Shen [1 ]
Fenglin Yan [1 ]
机构：
[1] Intensive Care Unit, School of Medicine, Mianyang Central Hospital, University of Electronic Science and Technology of China, No.12 Changjia Alley, Jingzhong Street, Fucheng District, Sichuan Province, Mianyang
来源：
BMC Anesthesiology | / 25卷 / 1期
关键词：
Anatomical landmark; Intensive care unit; Tracheostomy; Ultrasound;
D O I：
10.1186/s12871-025-03085-z
中图分类号：
学科分类号：
摘要：
Background: Percutaneous dilatational tracheostomy (PDT) is increasingly used in intensive care units owing to its advantages of reduced surgical trauma and fewer complications. Recently, ultrasonography has become a potentially useful tool for assisting PDT. Objective: To compare ultrasound- and landmark-guided PDT for major bleeding, first-puncture success rates, periprocedural complications, and tracheotomy procedure times. Methods: Randomized controlled trials (RCTs) or non-RCTs comparing ultrasound- and landmark-guided PDT were searched for in PubMed, Web of Science, MEDLINE, CINAHL, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Infrastructure (CNKI) and the Chinese Biomedical Literature Service System (SinoMed). The primary outcomes were major bleeding and first puncture success rate. Secondary outcomes were periprocedural complications and the tracheotomy procedure time. The meta-analysis was performed using RevMan 5.3 software. Results: This meta-analysis included five RCTs and one non-RCT, with a total of 609 patients. Compared with landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding (odds ratio [OR] = 0.35, 95% confidence interval [CI; 0.14, 0.90], P = 0.03) and improved the success rate of first puncture (OR = 4.41, 95% CI [2.54, 7.65], P < 0.000001). Additionally, ultrasound-guided PDT is associated with a lower incidence of periprocedural complications (OR = 0.35, 95% CI [0.22, 0.54], P < 0.00001). However, there was no advantage in reducing the tracheotomy procedure time between the two methods (mean difference = − 0.64, 95% CI [–4.14, 2.85], P = 0.72). Conclusion: Compared to landmark-guided PDT, ultrasound-guided PDT can reduce the incidence of major bleeding and periprocedural complications and increase the success rate of the first puncture. However, the advantage of ultrasound-guided PDT in reducing the tracheotomy procedure time is unclear. © The Author(s) 2025.
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