Percutaneous versus surgical tecnhique for tracheostomy on adults patients in long-term mechanical ventilation: a rapid evidence synthesis

Abstract

Background: Surgical tracheostomy (ST) or percutaneous tracheostomy (PT) are commonly performed on patients in long-term mechanical ventilation, not having an analysis of the strength of evidence in favour of one of these procedures.

Aim and Objective: Our aim was to evaluate the effectiveness and safety of percutaneous tracheostomy compared to surgical as well as to describe the level of evidence and rate the strength of evidence.

Methods: The following electronic databases were searched: PubMed, Scopus, Embase, Cochrane, Cinhal, Web Science and BVS/Lilacs until November 2, 2019. Systematic reviews with and without meta-analysis and randomized and non-randomized clinical trials comparing PT (intervention) with ST (comparison) used in long-term ventilator-dependent adult patients were included. Risk of bias was assessed using ROBIS tool and the quality of the evidence was addressed using GRADE method.

Results: 1024 articles were retrieved by the search, 260 were duplicated. 764 were screened by title and abstract, 742 were excluded. Of the 22 selected for reading the full text, 21 were excluded and only 1 systematic review was included. There were 1795 procedures (PT=926; ST=869). No significant difference was found in the risk of a potentially fatal event (difference in risk (RD) 0.01, 95% CI-0.03 to 0.05, P=0.62, I²=47%) between PT and ST. There was no difference in mortality (RD -0.00, 95% CI-0.01 to 0.01, P=0.88, I²=0%), however stoma infection occurred more frequently with ST (RD-0.05, 95% CI-0.08 to -0.02, P=0.003, I²=60%).

Conclusion: There is strong evidence that PT is a safe procedure with few life-threatening events and similar to the ST.