Timing of Tracheostomy in Critically Ill Patients: A Meta-Analysis

Abstract

ObjectiveTo compare important outcomes between early tracheostomy (ET) and late tracheostomy (LT) or prolonged intubation (PI) for critically ill patients receiving long-term ventilation during their treatment.MethodWe performed computerized searches for relevant articles on PubMed, EMBASE, and the Cochrane register of controlled trials (up to July 2013). We contacted international experts and manufacturers. We included in the study randomized controlled trials (RCTs) that compared ET (performed within 10 days after initiation of laryngeal intubation) and LT (after 10 days of laryngeal intubation) or PI in critically ill adult patients admitted to intensive care units (ICUs). Two investigators evaluated the articles; divergent opinions were resolved by consensus.ResultsA meta-analysis was evaluated from nine randomized clinical trials with 2,072 participants. Compared to LT/PI, ET did not significantly reduce short-term mortality [relative risks (RR) = 0.91; 95% confidence intervals (CIs) = 0.81–1.03; p = 0.14] or long-term mortality (RR = 0.90; 95% CI = 0.76–1.08; p = 0.27). Additionally, ET was not associated with a markedly reduced length of ICU stay [weighted mean difference (WMD) = −4.41 days; 95% CI = −13.44–4.63 days; p = 0.34], ventilator-associated pneumonia (VAP) (RR = 0.88; 95% CI = 0.71–1.10; p = 0.27) or duration of mechanical ventilation (MV) (WMD = − 2.91 days; 95% CI = −7.21–1.40 days; p = 0.19).ConclusionAmong the patients requiring prolonged MV, ET showed no significant difference in clinical outcomes compared to that of the LT/PI group. But more rigorously designed and adequately powered RCTs are required to confirm it in future.

Incidence of ventilator associated pneumonia in tracheostomised and non tracheostomised patients

“…In our study majority of the patients (54.76%) underwent tracheostomy within 7 to 10 days of mechanical ventilation which was similar to the studies done by Chaari et al and Huang et al 12,13 In our study, the total incidence of VAP was 44%. In our study out of the 42 patients who had undergone tracheostomy 13 (30.95%) patients had ventilator associated pneumonia which was similar to the study done by Chaari et al 12 Among the non tracheostomised patients 31 (53.44%) out of 58 patients developed ventilator associated pneumonia.…”

Early versus late tracheostomy in cardiovascular intensive care patients

“…A recent meta-analysis published for Huang et al evaluated 9 randomized clinical trials with 2,072 patients [12]. Compared to LT or prolonged MV, they did not find significantly difference of ET in terms of short-term mortality [relative risk (RR) = 0.91; 95% confidence intervals (cIs) = 0.81−1.03; P = 0.14] or long-term mortality VAP or duration of MV.…”

Percutaneous tracheostomy: a comprehensive review

“…A meta-analysis of nine randomized clinical trials with 2,072 participants showed that early tracheostomy had no significant influence on clinical outcomes (shortterm mortality, long-term mortality, length of ICU stay, ventilator-associated pneumonia or duration of mechanical ventilation) compared to late tracheostomy or prolonged intubation (42). Although, two more recent analyses suggest superiority of early tracheostomy (43,44), the timing of tracheostomy is dependent mostly on individual and institutional practice.…”