Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation.
OBJECTIVE
To compare outcomes in critically ill patients undergoing artificial ventilation who received a tracheostomy early or late in their treatment.


METHODS
The Cochrane Central Register of Clinical Trials, Medline, Embase, CINAHL, the National Research Register, the NHS Trusts Clinical Trials Register, the Medical Research Council UK database, the NHS Research and Development Health Technology Assessment Programme, the British Heart Foundation database, citation review of relevant primary and review articles, and expert informants.


METHODS
Randomised and quasi-randomised controlled studies that compared early tracheostomy with either late tracheostomy or prolonged endotracheal intubation. From 15,950 articles screened, 12 were identified as "randomised or quasi-randomised" controlled trials, and five were included for data extraction.


METHODS
Five studies with 406 participants were analysed. Descriptive and outcome data were extracted. The main outcome measure was mortality in hospital. The incidence of hospital acquired pneumonia, length of stay in a critical care unit, and duration of artificial ventilation were also recorded. Random effects meta-analyses were performed.


RESULTS
Early tracheostomy did not significantly alter mortality (relative risk 0.79, 95% confidence interval 0.45 to 1.39). The risk of pneumonia was also unaltered by the timing of tracheostomy (0.90, 0.66 to 1.21). Early tracheostomy significantly reduced duration of artificial ventilation (weighted mean difference -8.5 days, 95% confidence interval -15.3 to -1.7) and length of stay in intensive care (-15.3 days, -24.6 to -6.1).


CONCLUSIONS
In critically ill adult patients who require prolonged mechanical ventilation, performing a tracheostomy at an earlier stage than is currently practised may shorten the duration of artificial ventilation and length of stay in intensive care.
Griffiths
John
J
Adult Intensive Care Unit, John Radcliffe Hospital, Oxford OX3 9DU.
Barber
Vicki S
VS
Morgan
Lesley
L
Young
J Duncan
JD
D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D007902:Length of Stay; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D013997:Time Factors; D014139:Tracheostomy / Q000379:methods* / Q000401:mortality