title: Effect of early tracheostomy on resource utilization and clinical outcomes in critically ill patients: meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Early tracheostomy may decrease the duration of mechanical ventilation, sedation exposure, and intensive care stay, possibly resulting in improved clinical outcomes, but the evidence is conflicting.
  
  
  METHODS
  Systematic review and meta-analysis of randomized trials in patients allocated to tracheostomy within 10 days of start of mechanical ventilation was compared with placement of tracheostomy after 10 days if still required. Medline, EMBASE, the Cochrane Controlled Clinical Trials Register, and Google Scholar were searched for eligible trials. The co-primary outcomes were mortality within 60 days, and duration of mechanical ventilation, sedation, and intensive care unit stay. Secondary outcomes were the number of tracheostomy procedures performed, and incidence of ventilator-associated pneumonia (VAP). Outcomes are described as relative risk or weighted mean difference with 95% confidence intervals.
  
  
  RESULTS
  Of note, 4482 publications were identified and 14 trials enrolling 2406 patients were included. Tracheostomy within 10 days was not associated with any difference in mortality [risk ratio (RR): 0.93 (0.83-1.05)]. There were no differences in duration of mechanical ventilation [-0.19 days (-1.13-0.75)], intensive care stay [-0.83 days (-2.05-0.40)], or incidence of VAP. However, duration of sedation was reduced in the early tracheostomy groups [-2.78 days (-3.68 to -1.88)]. More tracheostomies were performed in patients randomly assigned to receive early tracheostomy [RR: 2.53 (1.18-5.40)].
  
  
  CONCLUSIONS
  We found no evidence that early (within 10 days) tracheostomy reduced mortality, duration of mechanical ventilation, intensive care stay, or VAP. Early tracheostomy leads to more procedures and a shorter duration of sedation.
authors.affiliation: Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK Cwm Taf UHB, Royal Glamorgan Hospital, Llantrisant, UK szakmanyt1@cardiff.ac.uk.
authors.forename: T
authors.initials: T
authors.lastname: Szakmany
authors.affiliation: Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
authors.forename: P
authors.initials: P
authors.lastname: Russell
authors.affiliation: Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Wilkes
authors.affiliation: Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
authors.forename: J E
authors.initials: JE
authors.lastname: Hall
mesh_terms: D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D053717:Pneumonia, Ventilator-Associated / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013997:Time Factors; D014139:Tracheostomy / Q000191:economics / Q000706:statistics & numerical data*
keywords: complications; early medical intervention; survival; tracheostomy; ventilator-associated pneumonia