Review Article Single dilator vs. guide wire dilating forceps tracheostomy: a meta-analysis of randomised trials L. Cabrini, G. Landoni, M. Greco, R. Costagliola, G. Monti, S. Colombo, T. Greco, L. Pasin, G. Borghi and A. Zangrillo Department of Anesthesia and Intensive Care, San Raffaele Scientific Institute, Milan, Italy Background: Single dilator technique (SDT) and guide wire dilating forceps (GWDF) are the two most commonly used tech- niques of percutaneous dilatational tracheostomy (PDT) in criti- cally ill adult patients. We performed a meta-analysis of randomised, controlled trials comparing intraoperative, mid- term and late complications of these two techniques. Methods: Pertinent studies were searched in BioMedCentral, PubMed, Embase and the Cochrane Central Register of clinical trials. We selected all randomised studies comparing SDT and GWDF techniques in adult critically ill patients published in a peer-reviewed journal. Results: Among 1040 retrieved studies, five eligible studies randomising 363 patients (181 to GWDF, 182 to SDT) were iden- tified. The incidence of the composite outcome difficult cannula insertion/difficult dilation or failure was higher with the GWDF technique (15.5% vs. 4.9 %, P = 0.02). Moreover, intraprocedural bleeding was more common in the GWDF group (19.3% vs. 7.6% in SDT group, P = 0.018). A trend towards an increased incidence of fracture of tracheal rings was noted in the SDT group (6.5% vs. 0.5% in the GWDF group, P = 0.13). No difference in mid-term or long-term complications was observed. Conclusion: GWDF technique is associated with a higher inci- dence of intraprocedural bleeding and of technical difficulties in completing the procedure (difficult cannula insertions/difficult dilations or failures) compared with the SDT technique. No dif- ferences were identified in mid-term and long-term complica- tions. Further studies comparing SDT and GWDF in the general population and in subgroups of high-risk patients (like obese or hypoxaemic patients) are warranted. Accepted for publication 7 September 2013 © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd P ercutaneous dilatational tracheostomy (PDT) is considered the technique of choice in critically ill adult patients. 1,2 Complications are rare 2 but can be life-threatening. 3 Single dilator technique (SDT, also known as ‘single-step’, ‘single-tapered dilator’ and frequently cited by its brand names ‘Ciaglia Blue Rhino’ or ‘Ultraperc’) and guide wire dilating forceps (GWDF, also known as ‘forceps dilatational’ or ‘Griggs’ technique’) are the two most commonly used techniques. 4–6 A recent systematic review comparing all the PDT techniques suggested that SDT and GWDF are associated with fewer perioperative complications. 7 However, the mid-term and long- term complications associated with each PDT tech- nique were not reported in this paper, and no preferential indications were specified to choose between these techniques. The publication of three recent randomised, controlled trials (RCTs) comparing SDT and GWDF 8–10 allowed to update the previously cited systematic review adding a meaningful meta-analytic comparison between the two techniques. We therefore performed a meta- analysis of RCTs comparing intraoperative, mid- term (with tracheostomy tube in situ) and late complications (after decannulation) of SDT and GWDF in critically ill adult patients. Methods Literature search Pertinent studies were independently searched in BioMedCentral, PubMed-Medline, Embase and the Cochrane Central Register of Clinical Trials (updated January 15th 2013) by three trained inves- tigators (CL, MG, CR). The Medline search strategy Acta Anaesthesiol Scand 2014; 58: 135–142 Printed in Singapore. All rights reserved © 2013 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd ACTA ANAESTHESIOLOGICA SCANDINAVICA doi: 10.1111/aas.12213 135