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Tracheostomy – Journal Summaries 20/9/10 PY Mindmaps PDT = Ciaglia Technique 1999 – Dulguerov et al, Critical Care Medicine - open vs perc. -> PDT+ Bronch = lowest complication rate in percutaneous group - percutaneous group = lower post op but higher perioperative complication rate 2000 – Cheng et al, Ann Otol Rhinol Laryngol - meta-analysis (including 4 RCT’s) - open vs PDT -> PDT = lower risk of infection and bleeding -> PDT + Bronch as safe as open tracheostomy 2000 – Freeman et al, Chest - meta-analysis (including 5 RCT’s) - open vs PDT -> no overall difference in mortality rate -> PDT: quicker, lower post op complications, less bleeding 2006 - Delaney et al, Crit Care Med - large meta-analysis (17 studies) - PDT vs open -> PDT: lower wound infection -> no difference in bleeding and complication rates 2007 – Higgins et al, Laryngoscope - PDT vs open - meta-analysis (15 studies) - PDT: less infection, less scarring, trend towards lower complication rate, faster, cheaper, lower conversion rate - PDT: higher accidental decannulation, no difference in bleeding, subglottic stenosis, death Griffiths, J et al (2005) “Systematic review and meta-analysis of the timing of tracheostomy in adult patients undergoing artificial ventilation” BMJ 330:1243-1247 - early vs later tracheostomy or prolonged ventilation - n = 406 - 5 papers -> no mortality difference -> no difference in risk of pneumonia -> significant decrease in duration of mechanical ventilation -> significant decrease in duration of ICU stay Jeremy Fernando (2010)