Early versus Late Tracheostomy: A Systematic Review and Meta-analysis

Abstract

Objectives:

(1) Describe the outcomes of early versus late tracheostomy in the critically ill patient population. (2) Apply these findings to the clinical setting when deciding on the timing of tracheostomy.

Methods:

A systematic search was performed of the Medline, PubMed, and Embase databases, as well as the Cochrane Central Register of Controlled Trials. Randomized controlled studies investigating the outcomes of early versus late tracheostomies were included. The primary outcome of interest was the length of mechanical ventilation. Secondary outcomes include intensive care unit length of stay, incidence of pneumonia, and hospital mortality. The meta-analysis was completed using RevMan 5.2 (Cochrane Collaboration, Oxford).

Results:

The systematic search yielded 14 studies. There was no significant difference in the length of mechanical ventilation, with a weighted mean difference of –7.28 days (95% confidence interval [CI] –17.66 to 3.10). There was a significant decrease in the length of intensive care unit (ICU) stay with a weighted mean difference of –12.1 days (95% CI –21.7 to –2.52). The weighted risk ratio for pneumonia was 0.79 (95% CI 0.65 to 0.97) and for hospital mortality was 0.84 (95% CI 0.64 to 1.09).

Conclusions:

Performing a tracheostomy within 8 days of intubation significantly decreased the length of ICU stay. It may also be associated with a modest decrease in the incidence of pneumonia. No difference was found in the length of mechanical ventilation or hospital mortality.