Safety and efficacy of ultrasonography before and during percutaneous dilatational tracheostomy in adult patients: A systematic review

Objective: A systematic review to examine the safety and efficacy of ultrasound before and/or during percutaneous dilatational tracheostomy (PDT). Methods: Systematic searches of MEDLINE, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were undertaken to identify trials reporting on safety and efficacy of using ultrasound guidance before and/or during PDT. Results: Ultrasound before PDT: no controlled trials; two observational studies suggested a possible benefit in avoiding serious complications by identifying vulnerable vascular structures. Real-time ultrasound during PDT: one controlled study, which retrospectively compared real-time ultrasound guidance with the landmark-guided technique and found it to be superior in avoiding cranial misplacement; it appeared to be safe and effective in two observational studies. Conclusions: There are currently no randomised controlled trials to establish the safety or efficacy of preprocedural and/or real-time intraprocedural ultrasound guidance during PDT compared with the current standard of care. One study supports the use of real-time ultrasound guidance during PDT in preventing cranial tracheostomy tube misplacement. Observational data suggest that preprocedural ultrasound may help prevent vascular complications and that real-time ultrasound guidance during PDT is likely safe, with a high success rate. A prospective randomised controlled trial evaluating its safety and efficacy compared with the traditional landmarkguided technique is required to establish its role in clinical practice.