Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials

Koji Hosokawa, Masaji Nishimura, Moritoki Egi, Jean-Louis Vincent, Koji Hosokawa, Masaji Nishimura, Moritoki Egi, Jean-Louis Vincent

Abstract

Introduction: The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy.

Methods: We searched PubMed and CENTRAL for randomized controlled trials that compared outcomes in patients managed with early and late tracheotomy. A random-effects meta-analysis, combining data from three a priori-defined categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days), was performed to estimate the weighted mean difference (WMD) or odds ratio (OR).

Results: Of the 142 studies identified in the search, 12, including a total of 2,689 patients, met the inclusion criteria. The tracheotomy rate was significantly higher with early than with late tracheotomy (87 % versus 53 %, OR 16.1 (5.7-45.7); p <0.01). Early tracheotomy was associated with more ventilator-free days (WMD 2.12 (0.94, 3.30), p <0.01), a shorter ICU stay (WMD -5.14 (-9.99, -0.28), p = 0.04), a shorter duration of sedation (WMD -5.07 (-10.03, -0.10), p <0.05) and reduced long-term mortality (OR 0.83 (0.69-0.99), p = 0.04) than late tracheotomy.

Conclusions: This updated meta-analysis reveals that early tracheotomy is associated with higher tracheotomy rates and better outcomes, including more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy.

Figures

Fig. 1
Fig. 1
Tracheostomy rate. Meta-analysis of the 12 studies. I-V inverse variance
Fig. 2
Fig. 2
a Duration of mechanical ventilation. Meta-analysis of the eight studies providing this information. b Ventilator-free days. Meta-analysis of the five studies providing this information. I-V inverse variance
Fig. 3
Fig. 3
a Duration of sedation. Meta-analysis of the four studies providing this information. b Sedation-free days. Meta-analysis of the three studies providing this information. I-V inverse variance
Fig. 4
Fig. 4
a Short-term mortality. Meta-analysis of the 11 studies providing this information. b Long-term mortality. Meta-analysis of the 7 studies providing this information. Data for 28-day, 30-day and ICU mortality were combined to show short-term mortality, and data for 1-year, 6-month and hospital mortality were combined as long-term mortality. I-V inverse variance

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Source: PubMed

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