Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: A randomized controlled trial

Goo, Zhen Qiang; Muthusamy, Karthikeyan

doi:10.1016/j.jocn.2022.02.011

“…Severe traumatic brain injury (STBI) is a common acute and critical condition in neurosurgery [2,3]. Severe traumatic brain injury accounts for 13%-21% of craniocerebral injuries and is characterized by critical and dangerous conditions, complexity, high mortal-ity rate, and poor prognosis [4][5][6]. Patients with severe craniocerebral injury all have different degrees of coma, cannot eat on their own, and have a significant metabolic response to systemic stress, resulting in impaired nutritional intake, metabolic disorders, and depletion of the body's original nutritional reserves, leading to varying degrees of malnutrition soon after admission to the hospital [7].…”

Section: Introductionmentioning

confidence: 99%

Clinical Indications for Extubation in Coma Patients with Severe Neurological Craniocerebral Injury with Meta-Analysis

Ma

¹

,

Han

²

,

He

³

et al. 2022

BioMed Research International

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Computer searches of the PubMed, Cochrane Library, and Embase databases for randomized controlled studies on the effects of intensive nutrition on clinical outcomes in patients with severe craniocerebral injury were conducted from the time of database creation to June 11, 2022, along with manual searches of the relevant literature. Two investigators independently screened the literature, extracted data, and evaluated the risk of bias of the included studies before the effect sizes were combined using RevMan 5.3 statistical software provided by the Cochrane Collaboration Network, and publication bias was detected using Stata 12.0 software. Meta-analysis showed that total protein levels were higher in the intensive nutrition group than in the regular nutrition group ( WMD = 4.96 g/L (1.57-8.34), P < 0.001 ); IgA levels were significantly higher in the intensive nutrition group than in the regular nutrition group ( SMD = 0.79 (0.51-1.07), P < 0.001 ; SMD = 0.98 (0.58-1.38), P < 0.001 ); IgG levels were significantly higher in the fortified group than in the regular group ( SMD = 0.98 (0.58-1.38), P < 0.001 ); CD4/CD8 was significantly higher in the fortified patients than in the regular patients with a combined effect size of WMD = 0.33 (0.18-0.48) ( P < RR = 0.45 (0.27-0.75), P = 0.002 ). The results show that effective support of early enteral nutrition can reduce the occurrence of gastrointestinal complications in patients, give them a better adaptation process to the gastrointestinal tract, and ensure the degree of tolerance of their gastric mucosa, thus absorbing more nutrition. Fortification significantly reduced the incidence of gastric retention in patients with craniocerebral injury ( RR = 0.19 (0.07-0.49), P < 0.001 ). In the subgroup analysis of the three groups, it was shown that, depending on the starting time, the total protein level and IgG level were better in the early nutrition at 24 h than in the late nutrition above 24h and that, depending on the starting dose, the total protein level, IgA, IgG, and CD4/CD8 were better in the intervention at doses above 30 mL/h, using the starting dose of 30 mL/h as the cut-off point. In the subgroup analysis based on different nutrition methods (enteral and parenteral nutrition), IgA levels and the incidence of bloating and diarrhea were better than those of parenteral nutrition in the indicators of enteral nutrition.

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“…Eighteen studies [ 5 , 20 – 30 , 32 – 36 , 38 ] reported data on the incidence of pneumonia. Pneumonia is a common clinical complication in mechanically ventilated patients.…”

Section: Resultsmentioning

confidence: 99%

“…The results of the sensitivity analysis showed that the conclusions were robust and not changed by excluding individual studies ( Fig 13 ). Seven studies [ 10 , 22 , 28 , 30 , 34 , 36 , 37 ] provided data on the length of hospital stay. The results showed that the timing of tracheotomy was not associated with the length of hospital stay (MD: -3.24; 95% CI: -7.99~1.52; P = 0.18; Fig 14 ), and there was significant heterogeneity among included trials (p<0.00001; I 2 = 83%; Fig 3H ).…”

Section: Resultsmentioning

confidence: 99%

“…However, a meta-analysis conducted by Chorath et al [ 19 ] suggested that early tracheotomy was associated with a lower incidence of ventilator-associated pneumonia, shorter mechanical ventilation, and length of ICU stay. Novel RCTs [ 36 – 38 ] on this topic have recently been published. These studies were not included in the new meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…We compared this study with recently published meta-analysis on this topic. Compared with the Chorath study [ 19 ], our study included seven other relevant RCTs [ 20 , 21 , 25 , 32 , 36 – 38 ]. Compared with the study of Deng et al [ 41 ], we included seven additional relevant RCTs [ 28 , 32 , 34 – 38 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effect of tracheotomy timing on patients receiving mechanical ventilation: A meta-analysis of randomized controlled trials

Han,

Gao,

Gao

et al. 2024

PLoS ONE

0

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Purpose We assessed the effects of tracheostomy timing (early vs. late) on outcomes among adult patients receiving mechanical ventilation. Methods PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant RCTs of tracheotomy timing on patients receiving mechanical ventilation. Two reviewers independently screened the literature, extracted data. Outcomes in patients with early tracheostomy and late tracheostomy groups were compared and analyzed. Meta-analysis was performed using Stata14.0 and RevMan 5.4 software. This study is registered with PROSPERO (CRD42022360319). Results Twenty-one RCTs were included in this Meta-analysis. The Meta-analysis indicated that early tracheotomy could significantly shorten the duration of mechanical ventilation (MD: -2.77; 95% CI -5.10~ -0.44; P = 0.02) and the length of ICU stay (MD: -6.36; 95% CI -9.84~ -2.88; P = 0.0003), but it did not significantly alter the all-cause mortality (RR 0.86; 95% CI 0.73~1.00; P = 0.06), the incidence of pneumonia (RR 0.86; 95% CI 0.74~1.01; P = 0.06), and length of hospital stay (MD: -3.24; 95% CI -7.99~ 1.52; P = 0.18). Conclusion In patients requiring mechanical ventilation, the tracheostomy performed at an earlier stage may shorten the duration of mechanical ventilation and the length of ICU stay but cannot significantly decrease the all-cause mortality and incidence of pneumonia.

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Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis

Jafari

¹

,

Mirmoeeni

²

,

Momtaz

³

et al. 2023

Neurocrit Care

3

0

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Early versus standard tracheostomy in ventilated patients in neurosurgical intensive care unit: A randomized controlled trial

Cited by 4 publications

References 50 publications

Clinical Indications for Extubation in Coma Patients with Severe Neurological Craniocerebral Injury with Meta-Analysis

Clinical Indications for Extubation in Coma Patients with Severe Neurological Craniocerebral Injury with Meta-Analysis

Effect of tracheotomy timing on patients receiving mechanical ventilation: A meta-analysis of randomized controlled trials

Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis

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