title: The effect of early and late tracheotomy on outcomes in patients: a systematic review and cumulative meta-analysis.
abstract: OBJECTIVE
  To compare the effect of early tracheotomy (ET) and late tracheotomy (LT) on ventilator-associated pneumonia (VAP) incidence and short-term mortality in critically ill patients who received mechanical ventilation.
  
  
  METHODS
  We searched databases of PubMed, Embase, and others for randomized controlled trials (RCTs) that compared ET (≤ 8 days after admission to the intensive care unit, initiation of translaryngeal intubation, or initiation of mechanical ventilation) with LT (≥ 6 days) in critically ill patients.
  
  
  METHODS
  The overall odds ratio (OR) was estimated by traditional meta-analysis. In addition, cumulative meta-analysis was conducted by adding 1 study at a time in the order of year of publication.
  
  
  RESULTS
  A total of 11 RCTs involving 1436 patients (708 in the ET group and 728 in the LT group) were included in this analysis. Early tracheotomy could significantly reduce the short-term mortality (OR = 0.74; 95% confidence interval [CI] [0.58, 0.95]) but did not reduce the VAP incidence (OR = 0.70; 95% CI [0.47, 1.04]). The cumulative meta-analysis showed that evidence of the benefit of ET on VAP incidence was unstable over time. In contrast, the difference in short-term mortality was stable from the first appearance during the cumulative meta-analysis.
  
  
  CONCLUSIONS
  Early tracheotomy could improve short-term mortality but did not alter VAP incidence. Many factors may be responsible for the unstable results during cumulative meta-analysis, and further study is still needed to explore the optimal timing of tracheotomy.
authors.affiliation: Department of Infectious Diseases, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Liu
authors.affiliation: Department of General Surgery, Maternal and Child Health Hospital of Pinggu District, Beijing, China.
authors.forename: Hong-Chao
authors.initials: HC
authors.lastname: Wang
authors.affiliation: Department of Infectious Diseases, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Ya-Wei
authors.initials: YW
authors.lastname: Xing
authors.affiliation: Department of Infectious Diseases, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Yan-Ling
authors.initials: YL
authors.lastname: He
authors.affiliation: Department of Thoracic Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China doczzf@163.com.
authors.forename: Ze-Feng
authors.initials: ZF
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, Fourth Affiliated Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
mesh_terms: D003422:Critical Care; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D012121:Respiration, Artificial / Q000009:adverse effects; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods* / Q000401:mortality*; D016896:Treatment Outcome
keywords: early tracheotomy; late tracheotomy; meta-analysis; short-term mortality; ventilator-associated pneumonia incidence