The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis

Wang, Ruohui; Pan, Changkun; Wang, Xiaokun; Xu, Feng; Jiang, Shuang; Li, Ming

doi:10.1016/j.hrtlng.2018.09.005

Cited by 74 publications

(68 citation statements)

References 28 publications

(18 reference statements)

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“…It is too soon to know if there will be any difference amongst the COVID-19 cohort of patients [11,12]. The incidence of ventilator-associated pneumonia and overall mortality does not improve with early tracheostomy in non-COVID populations [13][14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Takhar

Walker

Tricklebank

et al. 2020

Eur Arch Otorhinolaryngol

165

208

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Purpose The COVID-19 pandemic is placing unprecedented demand upon critical care services for invasive mechanical ventilation. There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal healthcare resource utilisation, and safety of healthcare workers when performing such a high-risk aerosol-generating procedure. Methods Literature review and proposed practical guideline based on the experience of a tertiary healthcare institution with 195 critical care admissions for COVID-19 up until 4th April 2020. Results A synthesis of the current international literature and reported experience is presented with respect to prognosis, viral load and staff safety, thus leading to a pragmatic recommendation that tracheostomy is not performed until at least 14 days after endotracheal intubation in COVID-19 patients. Practical steps to minimise aerosol generation in percutaneous tracheostomy are outlined and we describe the process and framework for setting up a dedicated tracheostomy team. Conclusion In selected COVID-19 patients, there is a role for tracheostomy to aid in weaning and optimise healthcare resource utilisation. Both percutaneous and open techniques can be performed safely with careful modifications to technique and appropriate enhanced personal protective equipment. ORL-HNS surgeons can play a valuable role in forming tracheostomy teams to support critical care teams during this global pandemic.

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Section: Introductionmentioning

confidence: 99%

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Takhar

Walker

Tricklebank

et al. 2020

Eur Arch Otorhinolaryngol

165

208

View full text Add to dashboard Cite

show abstract

“…Thus, the proportion of patients undergoing tracheostomy in Taiwan is much lower than that in the US. The US literature discusses early tracheostomy or late tracheostomy for ICU patients, which provides patients using ventilators a better course of treatment and better prognosis [3][4][5][6]. Combes discussed in his study that ICU patients with an early tracheostomy had better survival than those who did not undergo a tracheostomy [7].…”

Section: Discussionmentioning

confidence: 99%

A tracheostomy shared decision making program in respiratory care center patients in Taiwan

Huang

Chen

2020

Preprint

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Background: Tracheostomy is recommended for respiratory care center prolonged mechanical ventilation patients who cannot be liberated from the ventilator in the short term. However, most patients or their families oppose having this procedure. We applied [If my family is difficulty liberated from the ventilator, do he/she need to undergo tracheostomy?] tracheostomy shared decision making program for respiratory care center prolonged mechanical ventilation patients. The program is expected to enable patients to undergo tracheostomy, improving patients’ medical care and outcomes. Methods: We apply tracheostomy shared decision making program to patients who were admitted to a respiratory care center. Data of patients in the respiratory care center who participated in tracheostomy shared decision making program were collected and analyzed. The survival of patients and the optimal decision marking of tracheostomy shared decision making program were tracked. Results: A total of 57 patients participated in tracheostomy shared decision making program. Of these, 39 patients (68.4%) were men, and 18 (31.6%) were women. The mean age was 69.6 years. At the end of the study, 37 patients underwent tracheostomy (64.9%), and 20 patients maintained endotracheal tube intubation (35.1%). There was no significant difference in the factors of concern and the degree of concern about the methods of treatment in the two group patients. Patients or their families of the two groups have a good understanding of the two methods of treatment. The survival rate of patients undergoing tracheostomy was 86.5%, but only 86.5% of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision making program. Conversely, the survival rate of patients who maintained endotracheal tube intubation was 40%, but the all of participants believed that they made an optimal decision based on the result of the tracheostomy shared decision making program. The overall 91.2% of participants made an optimal decision marking of the tracheostomy shared decision making program. Conclusions: The clinical application of tracheostomy shared decision making program has achieved excellent results. Patients who underwent tracheostomy will have a longer survival time.

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“…Se podría establecer que la traqueotomía precoz no aporta beneficios en variables como neumonía asociada a ventilación mecánica o mortalidad, pero parece razonable realizarla a los pacientes con una elevada probabilidad de ventilación mecánica prolongada, por sus beneficios frente a la intubación en términos de bienestar, estancia en la UCI y tiempo de ventilación mecánica 13 . Un metaanálisis reciente solo mostró resultados sobre la reducción del uso de sedantes en relación con el momento de la traqueotomía 14 .…”

Section: Momento De La Traqueotomía En El Paciente Con Covid-19unclassified

Documento de consenso de la Sociedad Española de Medicina Intensiva, Crítica, y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19

Vadell¹,

Delgado²,

Avilés‐Jurado

et al. 2020

Revista Española de Anestesiología y Reanimación

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The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis

Cited by 74 publications

References 28 publications

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

Recommendation of a practical guideline for safe tracheostomy during the COVID-19 pandemic

A tracheostomy shared decision making program in respiratory care center patients in Taiwan

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