0
Original Research |

The Timing of Tracheotomy in Critically Ill Patients Undergoing Mechanical VentilationEarly Tracheotomy in Critically Ill Patients: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Fei Wang, MD, PhD; Youping Wu, MD, PhD; Lulong Bo, MD, PhD; Jingsheng Lou, MD, PhD; Jiali Zhu, MD; Feng Chen, MD, PhD; Jinbao Li, MD, PhD; Xiaoming Deng, MD, PhD
Author and Funding Information

From the Department of Anesthesiology and Critical Care, Changhai Hospital, Second Military Medical University, Shanghai, China.

Correspondence to: Xiaoming Deng, MD, PhD, Department of Anesthesiology and Critical Care, Changhai Hospital, Second Military Medical University, Shanghai 200433, China; e-mail: deng_x@yahoo.com

Data are presented as mean ± SD unless indicated otherwise. APACHE = Acute Physiology and Chronic Health Evaluation; CDC = Centers for Disease Control and Prevention; CPIS = Clinical Pulmonary Infection Score; MV = mechanical ventilation; SAPS = Simplified Acute Physiologic Score; VAP = ventilator-associated pneumonia.

Median (range).

ET = early tracheotomy; LT = late tracheotomy. See Table 1 legend for expansion of other abbreviations.

a

1-60 d duration, median (range), P = .64.

b

Mean (interquartile range).

Drs Wang, Wu, and Bo contributed equally to this article. Drs Deng and Li were considered senior authors.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Drs Wang, Wu, and Bo contributed equally to this article. Drs Deng and Li were considered senior authors.

Drs Wang, Wu, and Bo contributed equally to this article. Drs Deng and Li were considered senior authors.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1456-1465. doi:10.1378/chest.11-2024
Text Size: A A A
Published online

Background:  The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically ill patients who received an early or late tracheotomy.

Methods:  A systematic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Central Register of Controlled Trials, the National Research Register, the National Health Service Trusts Clinical Trials Register, and the Medical Research Council UK database was conducted using specific search terms. Eligible studies were RCTs that compared early tracheotomy (ET) with either late tracheotomy or prolonged endotracheal intubation in critically ill adult patients.

Results:  Seven trials with 1,044 patients were analyzed. ET did not significantly reduce short-term mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.13), long-term mortality (RR, 0.84; 95% CI, 0.68-1.04), or incidence of ventilator-associated pneumonia (RR, 0.94; 95% CI, 0.77-1.15) in critically ill patients. The timing of the tracheotomy was not associated with a markedly reduced duration of mechanical ventilation (MV) (weighted mean difference [WMD], −3.90 days; 95% CI, −9.71-1.91) or sedation (WMD, −7.09 days; 95% CI, −14.64-0.45), shorter stay in ICU (WMD, −6.93 days; 95% CI, −16.50-2.63) or hospital (WMD, 1.45 days; 95% CI, −5.31-8.22), or more complications (RR, 0.94; 95% CI, 0.66-1.34).

Conclusions:  The present meta-analysis suggested that the timing of the tracheotomy did not significantly alter important clinical outcomes in critically ill patients. The duration of MV and sedation, as well as the long-term outcomes of ET in mechanically ventilated patients, should be evaluated in rigorously designed and adequately powered RCTs in the future.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543