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Meta-Analysis
. 2014 Mar 25;9(3):e92981.
doi: 10.1371/journal.pone.0092981. eCollection 2014.

Timing of tracheostomy in critically ill patients: a meta-analysis

Huibin Huang  1 , Ying Li  1 , Felinda Ariani  2 , Xiaoli Chen  1 , Jiandong Lin  1
Affiliations
Meta-Analysis

Timing of tracheostomy in critically ill patients: a meta-analysis

Huibin Huang et al. PLoS One. .

Abstract

Objective: To compare important outcomes between early tracheostomy (ET) and late tracheostomy (LT) or prolonged intubation (PI) for critically ill patients receiving long-term ventilation during their treatment.

Method: We performed computerized searches for relevant articles on PubMed, EMBASE, and the Cochrane register of controlled trials (up to July 2013). We contacted international experts and manufacturers. We included in the study randomized controlled trials (RCTs) that compared ET (performed within 10 days after initiation of laryngeal intubation) and LT (after 10 days of laryngeal intubation) or PI in critically ill adult patients admitted to intensive care units (ICUs). Two investigators evaluated the articles; divergent opinions were resolved by consensus.

Results: A meta-analysis was evaluated from nine randomized clinical trials with 2,072 participants. Compared to LT/PI, ET did not significantly reduce short-term mortality [relative risks (RR) = 0.91; 95% confidence intervals (CIs) = 0.81-1.03; p = 0.14] or long-term mortality (RR = 0.90; 95% CI = 0.76-1.08; p = 0.27). Additionally, ET was not associated with a markedly reduced length of ICU stay [weighted mean difference (WMD) = -4.41 days; 95% CI = -13.44-4.63 days; p = 0.34], ventilator-associated pneumonia (VAP) (RR = 0.88; 95% CI = 0.71-1.10; p = 0.27) or duration of mechanical ventilation (MV) (WMD = - 2.91 days; 95% CI = -7.21-1.40 days; p = 0.19).

Conclusion: Among the patients requiring prolonged MV, ET showed no significant difference in clinical outcomes compared to that of the LT/PI group. But more rigorously designed and adequately powered RCTs are required to confirm it in future.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Selection process for randomized controlled trials included in the meta-analysis.
Figure 2
Figure 2. Risk of bias graph: the authors’ judgments about each risk-of-bias item presented as percentages across all included studies.
Figure 3
Figure 3. Risk-of-bias summary: the authors’ judgments about each risk-of-bias item for the included studies.
Figure 4
Figure 4. Forest plot showing the short-term mortality between the ET group and the LT/PI group.
Figure 5
Figure 5. Forest plot showing the comparison of the long-term mortality between the ET group and the LT/PI group.
Figure 6
Figure 6. Forest plot showing the comparison of the duration of MV between the ET group and the LT/PI group.
Figure 7
Figure 7. Forest plot showing the comparison of the length of ICU stay between the ET group and the LT/PI group.
Figure 8
Figure 8. Forest plot showing the incidence of VAP between the ET group and the LT/PI group.
Figure 9
Figure 9. Tests for publication bias for RR of the shorter-term mortality.
See this image and copyright information in PMC

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