{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T01:53:35Z","timestamp":1790387615896,"version":"4.1.0"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Percutaneous dilatational tracheostomy (PDT) is widely performed in critically ill patients. In contemporary intensive care units (ICUs), multimodal image-guided PDT (particularly the combination of ultrasound and bronchoscopy) is increasingly advocated to maximize procedural safety. However, randomized data comparing single-modality guidance strategies remain clinically relevant, especially where one modality is unavailable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing ultrasound-guided PDT with anatomical landmark-guided PDT or bronchoscopy-guided PDT. Four databases were searched from inception to February 16, 2026. Primary outcome was overall procedural complication rate. Secondary outcomes included first-attempt success rate, bleeding events, and procedure time. Random-effects models were used to pool risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 11 RCTs (1,035 patients) were included. Compared with other percutaneous PDT techniques, ultrasound-guided PDT significantly reduced the risk of overall procedural complications (RR 0.56, 95% CI 0.46 to 0.69,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.00001, I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f75%) improved the first-attempt success rate (RR 1.23, 95% CI 1.08 to 1.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.003, I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f54%), and reduced the incidence of bleeding events (RR 0.44, 95% CI 0.29 to 0.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.0001, I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f0%). No significant difference in procedure time was observed between ultrasound-guided and comparator techniques (MD \u22121.20, 95% CI \u22124.13 to 1.74,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.42, I\n                      <jats:sup>2<\/jats:sup>\n                      \u202f=\u202f98%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In critically ill adults undergoing percutaneous tracheostomy, ultrasound guidance is associated with higher first-attempt success, lower risks of overall complications and bleeding, without prolonging procedure duration. These findings support ultrasound-guided PDT as a preferred percutaneous approach. Nevertheless, these findings should be interpreted within modern practice, where combined ultrasound plus bronchoscopy is often considered the preferred safety strategy in well-equipped ICUs, particularly for high-risk anatomy and re-intervention cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:uri>https:\/\/osf.io\/7wgzu<\/jats:uri>\n                      , identifier.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1818411","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:32:31Z","timestamp":1774935151000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound-guided percutaneous dilatational tracheostomy versus landmark- and bronchoscopy-guided techniques in critically ill patients: a systematic review and meta-analysis of randomized controlled trials"],"prefix":"10.3389","volume":"13","author":[{"given":"Binbin","family":"Ren","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Affiliated Jinhua Hospital, Zhejiang University School of Medicine","place":["Jinhua, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yilu","family":"Bao","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, The First People's Hospital of Taizhou","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghang","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, The First People's Hospital of Taizhou","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, The First People's Hospital of Taizhou","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biyun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Ultrasound Medicine, The First People's Hospital of Taizhou","place":["Taizhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1378\/chest.87.6.715","article-title":"Elective percutaneous dilatational tracheostomy. 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tracheostomy?","volume":"71","author":"Ravi","year":"2015","journal-title":"Med J Armed Forces India"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s13054-014-0514-0","article-title":"Traditional landmark versus ultrasound guided tracheal puncture during percutaneous dilatational tracheostomy in adult intensive care patients: a randomised controlled trial","volume":"18","author":"Rudas","year":"2014","journal-title":"Crit Care"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"191","DOI":"10.1177\/0885066617705641","article-title":"Comparison of bronchoscopy-guided and real-time ultrasound-guided percutaneous dilational tracheostomy: safety, complications, and effectiveness in critically ill patients","volume":"34","author":"Sar\u0131ta\u015f","year":"2017","journal-title":"J Intensive Care Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1186\/s12890-025-03645-6","article-title":"Real-time ultrasound-guided laryngeal mask assisted percutaneous dilatational tracheostomy versus bronchoscopy-guided percutaneous dilatational tracheostomy in critically ill patients: a randomized controlled trial","volume":"25","author":"Taha","year":"2025","journal-title":"BMC Pulm Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1148\/radiol.14140088","article-title":"Advantages of US in percutaneous dilatational tracheostomy: randomized controlled trial and review of the literature","volume":"273","author":"Yavuz","year":"2014","journal-title":"Radiology"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"7883","DOI":"10.26355\/eurrev_202211_30139","article-title":"Comparative effectiveness of real-time ultrasound-guided tracheostomy and anatomic landmark percutaneous dilatational tracheostomy: a retrospective cohort study","volume":"26","author":"Topcu","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1002\/j.2205-0140.2012.tb00197.x","article-title":"The role of ultrasound in percutaneous dilatational tracheostomy","volume":"15","author":"Rudas","year":"2012","journal-title":"Australas J Ultrasound Med"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"R67","DOI":"10.1186\/cc10047","article-title":"Real-time ultrasound-guided percutaneous dilatational tracheostomy: a feasibility study","volume":"15","author":"Rajajee","year":"2011","journal-title":"Crit Care"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"104146","DOI":"10.1016\/j.amjoto.2023.104146","article-title":"Impact of radiological surveillance for major blood vessels on complications of percutaneous dilatational tracheostomy: a retrospective cohort study","volume":"45","author":"Noy","year":"2024","journal-title":"Am J Otolaryngol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"450","DOI":"10.4097\/kja.23900","article-title":"Ultrasound mapping of soft tissue vascular anatomy proximal to the larynx: a prospective cohort study","volume":"77","author":"De Cassai","year":"2024","journal-title":"Korean J Anesthesiol"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1034\/j.1399-0020.2000.290313.x","article-title":"Percutaneous dilatational tracheostomy: haemorrhagic complications and the vascular anatomy of the anterior neck. A review based on 497 cases","volume":"29","author":"Muhammad","year":"2000","journal-title":"Int J Oral Maxillofac Surg"},{"key":"ref43","doi-asserted-by":"publisher","DOI":"10.1002\/lary.70397","article-title":"Landmark-guided percutaneous tracheostomy without visualization in resource-limited settings","volume":"7","author":"Lee","year":"2026","journal-title":"Laryngoscope"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"3668","DOI":"10.21037\/jtd-24-172","article-title":"Optimal methodology for percutaneous dilatational tracheostomy: a comparative analysis between conventional and multidisciplinary approaches utilizing ultrasound, flexible bronchoscopy, and microcatheter puncture in critically ill individuals of diminutive stature-a longitudinal single-institutional experience and retrospective analysis","volume":"16","author":"Lee","year":"2024","journal-title":"J Thorac Dis"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1378\/chest.123.5.1595","article-title":"Percutaneous dilatational tracheostomy in the ICU: optimal organization, low complication rates, and description of a new complication","volume":"123","author":"Polderman","year":"2003","journal-title":"Chest"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1186\/s12871-025-03371-w","article-title":"Efficacy of ultrasound localization and fiberoptic bronchoscopy-guided percutaneous dilatational tracheostomy in the intensive care unit","volume":"25","author":"Zhang","year":"2025","journal-title":"BMC Anesthesiol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1818411\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T05:32:33Z","timestamp":1774935153000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1818411\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,31]]},"references-count":46,"alternative-id":["10.3389\/fmed.2026.1818411"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1818411","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,31]]},"article-number":"1818411"}}