title: Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials.
abstract: BACKGROUND
  The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy.
  
  
  METHODS
  We searched PubMed and CENTRAL for randomized controlled trials that compared outcomes in patients managed with early and late tracheotomy. A random-effects meta-analysis, combining data from three a priori-defined categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days), was performed to estimate the weighted mean difference (WMD) or odds ratio (OR).
  
  
  RESULTS
  Of the 142 studies identified in the search, 12, including a total of 2,689 patients, met the inclusion criteria. The tracheotomy rate was significantly higher with early than with late tracheotomy (87 % versus 53 %, OR 16.1 (5.7-45.7); p <0.01). Early tracheotomy was associated with more ventilator-free days (WMD 2.12 (0.94, 3.30), p <0.01), a shorter ICU stay (WMD -5.14 (-9.99, -0.28), p = 0.04), a shorter duration of sedation (WMD -5.07 (-10.03, -0.10), p <0.05) and reduced long-term mortality (OR 0.83 (0.69-0.99), p = 0.04) than late tracheotomy.
  
  
  CONCLUSIONS
  This updated meta-analysis reveals that early tracheotomy is associated with higher tracheotomy rates and better outcomes, including more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy.
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. khosok@gmail.com.
authors.forename: Koji
authors.initials: K
authors.lastname: Hosokawa
authors.affiliation: Department of Emergency and Critical Care Medicine, Tokushima University Hospital, Tokushima, Japan. nmasaji@tokushima-u.ac.jp.
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
authors.affiliation: Department Intensive Care, Kobe University Hospital, Kobe-city, Hyogo, Japan. moriori@tg8.so-net.ne.jp.
authors.forename: Moritoki
authors.initials: M
authors.lastname: Egi
authors.affiliation: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium. jlvincen@ulb.ac.be.
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Vincent
mesh_terms: D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D009026:Mortality; D016032:Randomized Controlled Trials as Topic; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013997:Time Factors; D014140:Tracheotomy / Q000379:methods*