Fei Wang1, Youping Wu1, Lulong Bo1, Jingsheng Lou1, Jiali Zhu1, Feng Chen1, Jinbao Li1, Xiaoming Deng2. 1. Department of Anesthesiology and Critical Care, Changhai Hospital, Second Military Medical University, Shanghai, China. 2. Department of Anesthesiology and Critical Care, Changhai Hospital, Second Military Medical University, Shanghai, China. Electronic address: deng_x@yahoo.com.
Abstract
BACKGROUND: The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically ill patients who received an early or late tracheotomy. METHODS: A systematic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Central Register of Controlled Trials, the National Research Register, the National Health Service Trusts Clinical Trials Register, and the Medical Research Council UK database was conducted using specific search terms. Eligible studies were RCTs that compared early tracheotomy (ET) with either late tracheotomy or prolonged endotracheal intubation in critically ill adult patients. RESULTS: Seven trials with 1,044 patients were analyzed. ET did not significantly reduce short-term mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.13), long-term mortality (RR, 0.84; 95% CI, 0.68-1.04), or incidence of ventilator-associated pneumonia (RR, 0.94; 95% CI, 0.77-1.15) in critically ill patients. The timing of the tracheotomy was not associated with a markedly reduced duration of mechanical ventilation (MV) (weighted mean difference [WMD], -3.90 days; 95% CI, -9.71-1.91) or sedation (WMD, -7.09 days; 95% CI, -14.64-0.45), shorter stay in ICU (WMD, -6.93 days; 95% CI, -16.50-2.63) or hospital (WMD, 1.45 days; 95% CI, -5.31-8.22), or more complications (RR, 0.94; 95% CI, 0.66-1.34). CONCLUSIONS: The present meta-analysis suggested that the timing of the tracheotomy did not significantly alter important clinical outcomes in critically ill patients. The duration of MV and sedation, as well as the long-term outcomes of ET in mechanically ventilated patients, should be evaluated in rigorously designed and adequately powered RCTs in the future.
BACKGROUND: The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically illpatients who received an early or late tracheotomy. METHODS: A systematic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Central Register of Controlled Trials, the National Research Register, the National Health Service Trusts Clinical Trials Register, and the Medical Research Council UK database was conducted using specific search terms. Eligible studies were RCTs that compared early tracheotomy (ET) with either late tracheotomy or prolonged endotracheal intubation in critically ill adult patients. RESULTS: Seven trials with 1,044 patients were analyzed. ET did not significantly reduce short-term mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.13), long-term mortality (RR, 0.84; 95% CI, 0.68-1.04), or incidence of ventilator-associated pneumonia (RR, 0.94; 95% CI, 0.77-1.15) in critically illpatients. The timing of the tracheotomy was not associated with a markedly reduced duration of mechanical ventilation (MV) (weighted mean difference [WMD], -3.90 days; 95% CI, -9.71-1.91) or sedation (WMD, -7.09 days; 95% CI, -14.64-0.45), shorter stay in ICU (WMD, -6.93 days; 95% CI, -16.50-2.63) or hospital (WMD, 1.45 days; 95% CI, -5.31-8.22), or more complications (RR, 0.94; 95% CI, 0.66-1.34). CONCLUSIONS: The present meta-analysis suggested that the timing of the tracheotomy did not significantly alter important clinical outcomes in critically illpatients. The duration of MV and sedation, as well as the long-term outcomes of ET in mechanically ventilated patients, should be evaluated in rigorously designed and adequately powered RCTs in the future.
Authors: Janice L Farlow; Pauline K Park; Michael W Sjoding; Stephen G Kay; Ross Blank; Kelly M Malloy; Laraine Washer; Lena M Napolitano; Venkatakrishna Rajajee; Michael J Brenner; Steven B Chinn; Jose De Cardenas Journal: J Thorac Dis Date: 2021-07 Impact factor: 3.005