title: [Timing of tracheotomy on the prognosis of patients with prolonged mechanical ventilation: a meta-analysis of randomized controlled trials].
abstract: OBJECTIVE
  To evaluate the effect of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients.
  
  
  METHODS
  Randomized controlled trials (RCTs) that studied the effect of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients were searched from Pubmed, Embase, The Cochrane Library, CBM during January 1990 to June 2010. The quality of the RCTs was evaluated. Meta-analysis of timing of tracheotomy on the prognosis of prolonged mechanically ventilated patients were conducted using the methods recommended by the Cochrane Collaboration. Definition of early tracheotomy was the patients performed tracheotomy during 10 days after admission to hospital or ICU, mechanical ventilation or intubation. Late tracheotomy was defined tracheotomy performed beyond 10 days of admission to hospital or ICU, mechanical ventilation or intubation; or those mechanically ventilated through intubation all the time.
  
  
  RESULTS
  Eight hundred and twenty eight patients, 411 in early tracheotomy group and 417 in late tracheotomy group, from 6 RCTs were included in the analysis of data. The meta-analysis showed that early tracheotomy could reduce mortality of patients (RR: 0.81, 95%CI: 0.66 - 0.99, P = 0.04); but it didn't significantly alter the incidence of pneumonia (RR:0.89, 95%CI: 0.68 - 1.17, P = 0.41), mechanical ventilation days (mean difference: -2.19, 95%CI: -9.86 - 5.49, P = 0.58) and length of ICU stay (mean difference: -5.65, 95%CI: -17.11 - 5.81, P = 0.33).
  
  
  CONCLUSIONS
  In critically ill adult patients who require prolonged mechanical ventilation, early tracheotomy performed at an earlier stage reduces the mortality, but doesn't reduce the incidence of pneumonia and shorten the mechanical ventilation days and ICU length of stay. But more high quality RCTs are required to confirm it.
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital and College of Clinical Medicine, Southeast University, Nanjing, China.
authors.forename: Yuan-hua
authors.initials: YH
authors.lastname: Lu
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Qiu
authors.forename: Feng-mei
authors.initials: FM
authors.lastname: Guo
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.forename: Hai-bo
authors.initials: HB
authors.lastname: Qiu
mesh_terms: D006801:Humans; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial; D013997:Time Factors; D014140:Tracheotomy