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Critical Care: Critical Care: Mechanical Ventilation |

Effect of Early Versus Late Tracheotomy in Critically Ill Patients: A Systematic Review and Meta-analysis FREE TO VIEW

Lei Pan, PhD; Yongzhong Guo, PhD
Author and Funding Information

Affiliated Hospital of Binzhou Medical University, Chinese PLA General Hospital, Binzhou, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A165. doi:10.1016/j.chest.2016.02.171
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SESSION TITLE: Critical Care: Mechanical Ventilation

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: To evaluate the effect of early versus late tracheotomy in adult critically ill patients receiving mechanical ventilation.

METHODS: A systematic literature search of PubMed and Embase (up to Apr 2015). Randomized controlled trials that compared early tracheotomy (ET) with either late tracheotomy or prolonged endotracheal intubation in mechanically ventilated adult patients were included. All data were derived with relative risks (RRs) and weighted mean differences (WMDs), and performed using Revman 5.2.0.

RESULTS: Fourteen studies with a total of 2515 patients met the inclusion criteria. Early tracheostomy did not significantly alter the risk of hospital acquired pneumonia (RR, 0.88; 95% CI, 0.75 to 1.03) and mortality (RR, 0.85; 95% CI, 0.69 to 1.06). However, early tracheostomy significantly reduced duration of ventilation (WMD, -6.91 days; 95% CI, -12.88 to -0.94) and length of stay in intensive care (WMD, -8.78 days; 95% CI, -14.46 to -3.10).

CONCLUSIONS: Current evidence showed that early tracheostomy did not significantly alter the risk of hospital acquired pneumonia and mortality; but obviously shortened the duration of ventilation and length of stay in intensive care, which should be efficacious in reducing the cost for patients in intensive care unit. However, further studies are needed in order to investigate our findings and the cost-effectiveness of early tracheostomy in mechanically ventilated patients.

CLINICAL IMPLICATIONS: Early tracheostomy did not significantly alter the risk of hospital acquired pneumonia and mortality; but obviously shortened the duration of ventilation and length of stay in intensive care. In terms of early or late tracheotomy, we believe that we should adopt the tailoring policy depending on the different patient's condition.

DISCLOSURE: The following authors have nothing to disclose: Lei Pan, Yongzhong Guo

No Product/Research Disclosure Information


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