title: Timing of tracheostomy in critically ill patients: a meta-analysis.
abstract: OBJECTIVE
  To compare important outcomes between early tracheostomy (ET) and late tracheostomy (LT) or prolonged intubation (PI) for critically ill patients receiving long-term ventilation during their treatment.
  
  
  METHODS
  We performed computerized searches for relevant articles on PubMed, EMBASE, and the Cochrane register of controlled trials (up to July 2013). We contacted international experts and manufacturers. We included in the study randomized controlled trials (RCTs) that compared ET (performed within 10 days after initiation of laryngeal intubation) and LT (after 10 days of laryngeal intubation) or PI in critically ill adult patients admitted to intensive care units (ICUs). Two investigators evaluated the articles; divergent opinions were resolved by consensus.
  
  
  RESULTS
  A meta-analysis was evaluated from nine randomized clinical trials with 2,072 participants. Compared to LT/PI, ET did not significantly reduce short-term mortality [relative risks (RR) = 0.91; 95% confidence intervals (CIs) = 0.81-1.03; p = 0.14] or long-term mortality (RR = 0.90; 95% CI = 0.76-1.08; p = 0.27). Additionally, ET was not associated with a markedly reduced length of ICU stay [weighted mean difference (WMD) = -4.41 days; 95% CI = -13.44-4.63 days; p = 0.34], ventilator-associated pneumonia (VAP) (RR = 0.88; 95% CI = 0.71-1.10; p = 0.27) or duration of mechanical ventilation (MV) (WMD = - 2.91 days; 95% CI = -7.21-1.40 days; p = 0.19).
  
  
  CONCLUSIONS
  Among the patients requiring prolonged MV, ET showed no significant difference in clinical outcomes compared to that of the LT/PI group. But more rigorously designed and adequately powered RCTs are required to confirm it in future.
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Huibin
authors.initials: H
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Pulmonary Medicine, Huadong Hospital, Shanghai Medical School of Fudan University, Shanghai, China.
authors.forename: Felinda
authors.initials: F
authors.lastname: Ariani
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Xiaoli
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Critical Care Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Lin
mesh_terms: D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome