Benefits of early tracheotomy: a meta-analysis based on 6 observational studies

Abstract

Background: Whether early tracheotomy can improve the clinical outcomes of critically ill patients remains controversial. The current study aimed to discuss the potential benefits of early tracheotomy compared to late tracheotomy with meta-analysis of observational studies.

Methods: An electronic search (up to February 28, 2013) was conducted by a uniform requirement, and then clinical data satisfying the predefined inclusion criteria were extracted.

Results: Data from a total of 2,037 subjects were included from 6 observational retrospective studies. Meta-analysis suggested that early tracheotomy was associated with significant reductions in mortality (odds ratio 0.77, 95% CI 0.62-0.96), duration of mechanical ventilation (mean difference -10.04, 95% CI -15.15 to -4.92), ICU stay (mean difference -8.80 d, 95% CI -9.71 to -7.89 d), and hospital stay (mean difference -12.18 d, 95% CI -18.25 to -6.11 d). However, as compared with late tracheotomy, early tracheotomy did not reduce the incidence of ventilator-associated pneumonia.

Conclusions: Our meta-analysis of retrospective observational studies suggests that early tracheotomy performed between days 3 and 7 after intubation had some advantages, including decreased mortality and reduced ICU stay, hospital stay, and mechanical ventilation duration in ICU patients.

Keywords: ICU; critically ill patients; mechanical ventilation; meta-analysis; tracheotomy.