Early versus Late Tracheostomy
- 12 December 2014
- journal article
- research article
- Published by Wiley in Otolaryngology -- Head and Neck Surgery
- Vol. 152 (2), 219-227
- https://doi.org/10.1177/0194599814561606
Abstract
To investigate whether early tracheostomy leads to improved outcomes compared with late tracheostomy. Ovid MEDLINE (including PubMed), Embase, and the Cochrane Central Register of Controlled Trials. A systematic search was performed of the above-mentioned databases according to PRISMA guidelines. Data were collected on the following outcomes of interest: hospital mortality, intensive care unit length of stay, length of mechanical ventilation, incidence of pneumonia, laryngotracheal injury, and sedation use. Analysis was performed using the RevMan 5 software (Cochrane Collaboration, Oxford, England). Eleven studies were included for analysis. There was a significant decrease in the intensive care unit length of stay in the early tracheostomy group (weighted mean difference, -9.13 days; 95% confidence interval [CI], -17.55 to -0.70; P = .03). There was no significant difference in hospital mortality (relative risk, 0.84; 95% CI, 0.67 to 1.04; P = .11). A pooled analysis was not performed for the incidence of pneumonia or length of mechanical ventilation, secondary to considerable heterogeneity among the studies. None of the studies reporting laryngotracheal outcomes found a significant difference between the early and late tracheostomy groups, whereas all 3 studies reporting sedation use found a significant decrease in the early tracheostomy group. Early tracheostomy performed within 7 days of intubation was associated with a decrease in intensive care unit length of stay. No difference was found in hospital mortality. Insufficient data currently exist to make conclusions about the effect of early tracheostomy on the incidence of pneumonia, length of mechanical ventilation, laryngotracheal injury, or sedation use.Keywords
This publication has 22 references indexed in Scilit:
- Stroke-Related Early Tracheostomy Versus Prolonged Orotracheal Intubation in Neurocritical Care Trial (SETPOINT)Stroke, 2013
- Risk of bias versus quality assessment of randomised controlled trials: cross sectional studyBMJ, 2009
- Early tracheotomy versus prolonged endotracheal intubation in unselected severely ill ICU patientsIntensive Care Medicine, 2008
- Tracheostomy in Ventilator Dependent Trauma Patients: A Prospective, Randomized Intention-to-Treat StudyThe Journal of Trauma and Acute Care Surgery, 2006
- Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilationBMJ, 2005
- Early Tracheostomy Does Not Improve Outcome in Burn PatientsJournal of Burn Care & Rehabilitation, 2002
- Laryngeal Complications of Prolonged IntubationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1989
- Consensus Conference on Artificial Airways in Patients Receiving Mechanical VentilationSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1989
- A prospective study of laryngotracheal sequelae in long‐term intubationThe Laryngoscope, 1984
- Prolonged Tracheal Intubation in the Trauma PatientThe Journal of Trauma and Acute Care Surgery, 1984