Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials

被引:141
作者
Hosokawa, Koji [1 ]
Nishimura, Masaji [2 ]
Egi, Moritoki [3 ]
Vincent, Jean-Louis [1 ]
机构
[1] Univ Libre Bruxelles, Dept Intens Care, Erasme Univ Hosp, B-1070 Brussels, Belgium
[2] Tokushima Univ Hosp, Dept Emergency & Crit Care Med, Tokushima, Japan
[3] Kobe Univ Hosp, Dept Intens Care, Kobe, Hyogo, Japan
关键词
Early tracheotomy; Systematic review; Mortality; PROLONGED TRANSLARYNGEAL INTUBATION; RECEIVING MECHANICAL VENTILATION; INTENSIVE-CARE-UNIT; EARLY TRACHEOSTOMY; ENDOTRACHEAL INTUBATION; RESOURCE UTILIZATION; TRAUMA PATIENTS; PNEUMONIA; MORTALITY; IMPACT;
D O I
10.1186/s13054-015-1138-8
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: 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.
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页数:12
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