Early tracheostomy may decrease the duration of mechanical ventilation, sedation exposure, and intensive care stay. These effects may result in improved clinical outcomes, but the evidence is conflicting. These authors evaluated the studies in this field.
Methods
Systematic review and meta-analysis of randomised trials in patients allocated to tracheostomy within 10 days of start of mechanical ventilation was compared with placement of tracheostomy after 10 days if still required. Medline, EMBASE, the Cochrane Controlled Clinical Trials Register, and Google Scholar were searched for eligible trials. The co-primary outcomes were mortality within 60 days, and duration of mechanical ventilation, sedation, and intensive care unit stay. Secondary outcomes were the number of tracheostomy procedures performed, and incidence of ventilator-associated pneumonia (VAP). Outcomes were described as relative risk or weighted mean difference with 95% confidence intervals.
Results
A total of 4482 publications were identified and 14 trials enrolling 2406 patients were included. Tracheostomy within 10 days was not associated with any difference in mortality (risk ratio [RR] 0.93 [0.83 to 1.05]). There were no differences in duration of mechanical ventilation (-0.19 days [-1.13 to 0.75]), intensive care stay (-0.83 days [-2.05 to 0.40]) or incidence of VAP. However, the duration of sedation was reduced in the early tracheostomy groups (-2.78 days [-3.68 to -1.88]). More tracheostomies were performed in patients randomly assigned to receive early tracheostomy (RR 2.53 [1.18 to 5.40]).
Conclusion
The authors conclude that there is no evidence that early (within 10 days) tracheostomy reduced mortality, duration of mechanical ventilation, intensive care stay or VAP. They state that early tracheostomy leads to more procedures and a shorter duration of sedation.
Tags: tracheostomia