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A Network Comparative Meta-analysis of Percutaneous Dilatational Tracheostomies Using Anatomic Landmarks, Bronchoscopic, and Ultrasound Guidance Versus Open Surgical Tracheostomy

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Abstract

Background

Several different tracheostomy techniques (percutaneous and surgical) have been studied extensively in previous direct pairwise meta-analyses. However, a network comparative meta-analysis comparing all has not been conducted before.

Objective

We sought to compare three percutaneous dilatational tracheostomy techniques with open surgical tracheostomy technique (performed in the operating room or in the intensive care unit by bedside) in terms of their association with procedure-related major complications and procedure time.

Data Sources

We searched PubMed and Cochrane register of randomized active comparator trials.

Data Extraction and Synthesis

A network comparative meta-analysis was performed in Stata using frequentist methodology. Major complications were defined as a composite of a priori-selected procedure-related complications. Tracheostomy techniques that did not require any direct bronchoscopic or ultrasonographic visualization of the entire procedure were grouped under the heading—anatomic landmark-based dilatational tracheostomy (ALDT). This along with bronchoscopic-guided dilatational tracheostomy (BDT), ultrasound-guided (UDT), and surgical tracheostomy (SGT) were compared with each other using network meta-analysis in Stata after all major assumptions (similarity, transitivity, and consistency) for performing a network were met. Log odds ratio (and standard errors) of the comparison of major complications between any two tracheostomy techniques (using indirect estimates) was statistically insignificant. Pairwise meta-analysis showed significant differences in procedure times between SGT and ALDT [mean difference: 9.96 min (SE 3.18)] and between SGT and BDT [15.67 min (SE 3.85)]. The indirect network meta-analysis comparing one versus the other also showed a statistically significant time difference between surgical tracheostomy when compared with every other technique.

Conclusions

The results of our network meta-analysis show that all tracheostomy techniques are comparable with respect to associated procedure-related complications, but all three percutaneous techniques take far less procedure time compared to the surgical tracheostomy.

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Author information

Authors and Affiliations

  1. Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Emory University School of Medicine, 613 Michael St, NE, Atlanta, GA, USA

    Imran H. Iftikhar, Mathew Schimmel & Alejandro Sardi

  2. Department of Otolaryngology, Medical College of Georgia, Augusta, GA, USA

    Stephanie Teng

  3. Division of Pulmonary, Allergy, Critical Care & Sleep Medicine, Medical College of Georgia, Augusta, GA, USA

    Crystal Duran & Shaheen Islam

Authors
  1. Imran H. Iftikhar
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  2. Stephanie Teng
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  3. Mathew Schimmel
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  6. Shaheen Islam
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Contributions

IHI had full access to all the extracted data in the network meta-analysis and takes responsibility for the integrity of the data and the accuracy of the data analysis. IHI designed the study protocol, conducted the analyses, and wrote the first draft manuscript. MS and CD contributed to data extraction and validation. IHI, ST, and AS contributed to assessment of study quality.

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Correspondence to Imran H. Iftikhar.

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Iftikhar, I.H., Teng, S., Schimmel, M. et al. A Network Comparative Meta-analysis of Percutaneous Dilatational Tracheostomies Using Anatomic Landmarks, Bronchoscopic, and Ultrasound Guidance Versus Open Surgical Tracheostomy. Lung 197, 267–275 (2019). https://doi.org/10.1007/s00408-019-00230-7

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