Open AccessEarly vs late tracheostomy in critically ill patients: a systematic review and meta‐analysis
Author(s) -
Meng Liang,
Wang Chunmei,
Li Jianxin,
Zhang Jian
Publication year - 2016
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12286
Subject(s) - medicine , sedation , mechanical ventilation , ventilator associated pneumonia , cochrane library , meta analysis , intubation , randomized controlled trial , relative risk , intensive care unit , confidence interval , anesthesia , incidence (geometry) , critically ill , pneumonia , physics , optics
Background and Aims This study aims to compare the outcomes of early tracheostomy ( ET ) (≤10 days after translaryngeal intubation) with late tracheostomy ( LT ) (>10 days after translaryngeal intubation) in critically ill patients with prolonged mechanical ventilation ( MV ). Methods We searched PubMed , EMBASE and the C ochrane L ibrary from inception to A pril 2014. We included all randomized controlled trials ( RCTs ), which compared ET with LT in critically ill patients. There was no language restriction. Two authors extracted data and conducted a quality assessment. Meta‐analyses using the fixed‐effects or random‐effects model were conducted for mortality, incidence of ventilator‐associated pneumonia ( VAP ), duration of MV and sedation, length of intensive care unit ( ICU ) stay. Results We enrolled 9 studies, in which a total of 2040 patients were randomized to either ET group ( N = 1018) or LT group ( N = 1022). ET might reduce the duration of sedation [weighted mean difference ( WMD ) = −5.99 days; 95% confidence intervals ( CI ) = −11.41 to −0.57 days; P = 0.03]. ET did not significantly alter the mortality [relative risk ( RR ) = 0.88; 95% CI = 0.76–1.00; P = 0.06], incidence of VAP ( RR = 0.84; 95% CI = 0.66–1.08; P = 0.17), duration of MV ( WMD = −4.46 days; 95% CI = −12.61 to 3.69 days; P = 0.28) and length of ICU stay ( WMD = −7.57 days; 95% CI = −15.42 to 0.29 days; P = 0.06). Conclusions Our meta‐analysis suggested that ET might be able to reduce the duration of sedation but did not significantly alter the mortality, incidence of VAP , duration of MV and length of ICU stay.