• André L N Gobatto, BesenBruno A M PBAMPhttps://orcid.org/0000-0002-3516-9696Medical Intensive Care Unit, Emergency Department, Hospital das Clínicas - University of Sao Paulo Medical School, São Paulo, Brazil.Intensive Care Unit, Hospital da Luz - Vila Mariana, São Paulo, B, Mino Cestari, Paolo Pelosi, and MalbouissonLuiz M SLMSDepartment of Anesthesiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.Trauma Intensive Care Unit, Surgery Emergency Department, Hospital das Clínicas, University of São Paulo Medical School, S.
• Department of Anesthesiology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
• J Intensive Care Med. 2020 May 1; 35 (5): 445-452.

IntroductionPercutaneous dilational tracheostomy (PDT) is a common and increasingly used procedure in the intensive care unit (ICU). It is usually performed with bronchoscopy guidance. Ultrasound has emerged as a useful tool in order to assist PDT, potentially improving its success rate and reducing procedural-related complications.ObjectiveTo investigate whether the ultrasound-guided PDT is equivalent or superior to the bronchoscopy-guided or anatomical landmarks-guided PDT with regard to procedural-related and clinical complications.MethodsA systematic review of randomized clinical trials was conducted comparing an ultrasound-guided PDT to the control groups (either a bronchoscopy-guided PDT or an anatomical landmark-guided PDT) in patients undergoing a PDT in the ICU. The primary outcome was the incidence of major procedural-related and clinical complication rates. The secondary outcome was the incidence of minor complication rates. Random-effect meta-analyzes were used to pool the results.ResultsFour studies fulfilled the inclusion criteria and they were analyzed. The studies included 588 participants. There were no differences in the major complication rates between the patients who were assigned to the ultrasound-guided PDT when compared to the control groups (pooled risk ratio [RR]: 0.48; 95% confidence interval [CI]: 0.13-1.71, I2 = 0%). The minor complication rates were not different between the groups, but they had a high heterogeneity (pooled RR: 0.49; 95% CI 0.16-1.50; I2 = 85%). The sensitivity analyzes that only included the randomized controlled trials that used a landmark-guided PDT as the control group showed lower rates of minor complications in the ultrasound-guided PDT group (pooled RR: 0.55; 95% CI: 0.31-0.98, I2 = 0%).ConclusionThe ultrasound-guided PDT seems to be safe and it is comparable to the bronchoscopy-guided PDT regarding the major and minor procedural-related or clinical complications. It also seems to reduce the minor complications when compared to the anatomical landmark-guided PDT.

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