2. Presented for fulfilment
of
Monthly Journal club discussion,
of
Department of ENT ,
TD Govt Medical college Alappuzha.
Under the supervision of
Associate Professor, Dr. Sujatha
By
Dr. Veena Mohan
Junior resident.
3. Selected article for presentation
• Authors- Maarit Heikkinen, Pertti Aarnio, Jorma Hannukainen
• Topic- Percutaneous dilatational tracheostomy or conventional surgical
tracheostomy.
• Journal name- Lippincott Williams and Wilkins,
Societ of Critical care medicine.
• Year- 2000, May
• Volume- 28
• Issue- 5
• Page- 1399-1402
• doi- 10.1097/00003246-200005000-00023
4. Journal information
• CCM is the leading journal in critical care and the official peer
reviewed scientific journal of the .
• Covers all aspect of acute emergency care , with acceptance rate
about 10-1 percent.
• With latest news on promising research, advanced in equipment and
technique.
• Provides free open access for selected journals and paid membership
for full articles.
5. • 12 issues of journals per year.
• Critical medicine ranking /3
• With impact factor-8.8 (year 2020)
6. Critical appraisal of journal
• Peer reviewed and open access.
• Paid journal
• Easily accessible once accepted.
• Good impact factor.
• Inclusion in major indexing such as pub med, google scholar.
• Accepted by ncbi.
• Article cited by 181.
7. Title of article
• Percutaneous dilatational tracheostomy or conventional surgical
tracheostomy?
8. Critical appraisal of title
• The title indicates the topic and focus study.
• The title is meaningful but appears incomplete with a question .
• It also indicates the research questions.
• The title clearly reflects aims and objectives of the study.
• The title is neither long nor short and does not look catchy .
10. Critical appraisal of abstract
• The abstract of the article is structured.
• It is informative and meaningful.
• It is comprehensive in its content.
• It clearly gives gist of the whole study.
11. RAPID CRITICAL APPRAISAL OF A
RANDOMIZED CONTROLLED TRIAL
• TITLE- PERCUTANEOUS DILATATIONAL TRACHEOSTOMY OR
CONVENTIONAL SURGICAL TRACHEOSTOMY?
• Level II- RCT
13. General description of study
• Purpose of study- to compare cost , complication and time consumption of
PDT with that of ST both when performed in ICU.
• Design method- prospective randomized trial
• Sample- 57 patients requiring prolonged mechanical ventilation.
• Setting- ICU of Satakunta central Hospital.
• Data collection-cost calculation table, reasons for tracheostomy table,
comparison table.
14. Quality of study
Validity
• Randomization- done
• Method of randomization-using a lot
• Demographic and clinical data –collected and compared
Age , gender, diagnosis, reason for tracheostomy, duration of
intubation before tracheostomy, intraprocedural complication, duration
of procedure, duration for preparation, consumption of sedative drugs,
cost of procedure.
15. • Aside from intervention ,were he group treated equally?- yes
• Were all patients who entered trial accounted for its conclusion?- yes
• Were patients analyzed in groups to which they were randomized?yes
• Well described and completed study?- yes
16. • Enough timeframe?- 23 months- tracheostomy decannulation could
not be studied.
• Instruments used were valid and reliable?- common surgeouns and
set up
• Freedom from conflict of interest?- nil
• Recent date of citations?- 2009
17. Reliability
• Sufficiently large sample size ?-57
• Main result?-PDT is significantly cost effective than ST
• Clinically significant? yes
• Potential confounders identified? Lack of experience of surgeons to
PDT, small stoma , tracheostomy tube of smaller size was ;ater
specially made.
• Adverse events identified?- yes
• Safety concerns described?-yes, under anesthesia cover
20. • Strength of study
Reliability
Structure
Mode of conduct
Organized presentation.
Data collection .
Data analysis.
21. • Weakness of study
Prior exposure to PDT for surgeons.
Mentioned Portex tracheostomy tube with manufacturer name.
11/57 were alive after 18 months.
Even though cost effective , surgical back up is a must in case of
complication for PDA.
23. Overall significance of article
• Findings are believable as journal is reliable
• Article is easy to understand.
• Helps to chose percutaneous tracheostomy over surgical
ttracheostomy.
