title: Early versus late tracheostomy: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate whether early tracheostomy leads to improved outcomes compared with late tracheostomy.
  
  
  METHODS
  Ovid MEDLINE (including PubMed), Embase, and the Cochrane Central Register of Controlled Trials.
  
  
  METHODS
  A systematic search was performed of the above-mentioned databases according to PRISMA guidelines. Data were collected on the following outcomes of interest: hospital mortality, intensive care unit length of stay, length of mechanical ventilation, incidence of pneumonia, laryngotracheal injury, and sedation use. Analysis was performed using the RevMan 5 software (Cochrane Collaboration, Oxford, England).
  
  
  RESULTS
  Eleven studies were included for analysis. There was a significant decrease in the intensive care unit length of stay in the early tracheostomy group (weighted mean difference, -9.13 days; 95% confidence interval [CI], -17.55 to -0.70; P = .03). There was no significant difference in hospital mortality (relative risk, 0.84; 95% CI, 0.67 to 1.04; P = .11). A pooled analysis was not performed for the incidence of pneumonia or length of mechanical ventilation, secondary to considerable heterogeneity among the studies. None of the studies reporting laryngotracheal outcomes found a significant difference between the early and late tracheostomy groups, whereas all 3 studies reporting sedation use found a significant decrease in the early tracheostomy group.
  
  
  CONCLUSIONS
  Early tracheostomy performed within 7 days of intubation was associated with a decrease in intensive care unit length of stay. No difference was found in hospital mortality. Insufficient data currently exist to make conclusions about the effect of early tracheostomy on the incidence of pneumonia, length of mechanical ventilation, laryngotracheal injury, or sedation use.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
authors.forename: C Carrie
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
authors.forename: Devon
authors.initials: D
authors.lastname: Livingstone
authors.affiliation: Division of General Surgery, Department of Surgery, University of Calgary, Alberta, Canada.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Calgary, Alberta, Canada Ohlson Research Initiative, University of Calgary, Alberta, Canada jdort@ucalgary.ca.
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Dort
mesh_terms: D016292:Procedural Sedation / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006801:Humans; D007049:Iatrogenic Disease; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D011014:Pneumonia / Q000453:epidemiology; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013997:Time Factors; D014139:Tracheostomy / Q000009:adverse effects / Q000379:methods*
keywords: meta-analysis; prolonged intubation; systematic review; tracheostomy; tracheotomy