Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis
- PMID: 34362103
- PMCID: PMC8348593
- DOI: 10.3390/jcm10153319
Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis
Abstract
Introduction. Tracheostomy can help weaning in long-term ventilated patients, reducing the duration of mechanical ventilation and intensive care unit length of stay, and decreasing complications from prolonged tracheal intubation. In traumatic brain injury (TBI), ideal timing for tracheostomy is still debated. We performed a systematic review and meta-analysis to evaluate the effects of timing (early vs. late) of tracheostomy on mortality and incidence of VAP in traumatic brain-injured patients. Methods. This study was conducted in conformity with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. We performed a search in PubMed, using an association between heading terms: early, tracheostomy, TBI, prognosis, recovery, impact, mortality, morbidity, and brain trauma OR brain injury. Two reviewers independently assessed the methodological quality of eligible studies using the Newcastle-Ottawa Scale (NOS). Comparative analyses were made among Early Tracheostomy (ET) and late tracheostomy (LT) groups. Our primary outcome was the odds ratio of mortality and incidence of VAP between the ET and LT groups in acute brain injury patients. Secondary outcomes included the standardized mean difference (MD) of the duration of mechanical ventilation, ICU length of stay (LOS), and hospital LOS. Results. We included two randomized controlled trials, three observational trials, one cross-sectional study, and three retrospective cohort studies. The total number of participants in the ET group was 2509, while in the LT group it was 2597. Early tracheostomy reduced risk for incidence of pneumonia, ICU length of stay, hospital length of stay and duration of mechanical ventilation, but not mortality. Conclusions. In TBI patients, early tracheostomy compared with late tracheostomy might reduce risk for VAP, ICU and hospital LOS, and duration of mechanical ventilation, but increase the risk of mortality.
Keywords: acute brain injury; early tracheostomy; late tracheostomy; mortality; tracheostomy timing; ventilatory acquired pneumonia.
Conflict of interest statement
The authors declare no conflict of interest.
Figures






Similar articles
-
Early Versus Late Tracheostomy in Patients With Acute Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis.Anesth Analg. 2021 Feb 1;132(2):384-394. doi: 10.1213/ANE.0000000000005212. Anesth Analg. 2021. PMID: 33009136
-
Association of Early vs Late Tracheostomy Placement With Pneumonia and Ventilator Days in Critically Ill Patients: A Meta-analysis.JAMA Otolaryngol Head Neck Surg. 2021 May 1;147(5):450-459. doi: 10.1001/jamaoto.2021.0025. JAMA Otolaryngol Head Neck Surg. 2021. PMID: 33704354 Free PMC article.
-
Is Early Tracheostomy Better for Severe Traumatic Brain Injury? A Meta-Analysis.World Neurosurg. 2018 Apr;112:e324-e330. doi: 10.1016/j.wneu.2018.01.043. Epub 2018 Jan 11. World Neurosurg. 2018. PMID: 29337171
-
Tracheostomy versus prolonged intubation in moderate to severe traumatic brain injury: a multicentre retrospective cohort study.Can J Anaesth. 2023 Sep;70(9):1516-1526. doi: 10.1007/s12630-023-02539-7. Epub 2023 Jul 28. Can J Anaesth. 2023. PMID: 37505417 Free PMC article.
-
Timing of Tracheostomy in ICU Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Life (Basel). 2024 Sep 14;14(9):1165. doi: 10.3390/life14091165. Life (Basel). 2024. PMID: 39337948 Free PMC article. Review.
Cited by
-
Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis.Neurocrit Care. 2024 Apr;40(2):551-561. doi: 10.1007/s12028-023-01778-2. Epub 2023 Jul 6. Neurocrit Care. 2024. PMID: 37415023 Review.
-
Clinical Management in Traumatic Brain Injury.Biomedicines. 2024 Apr 2;12(4):781. doi: 10.3390/biomedicines12040781. Biomedicines. 2024. PMID: 38672137 Free PMC article. Review.
-
Factors Associated With Time to Decannulation in Patients With Tracheostomy Following Severe Traumatic Brain Injury.Respir Care. 2024 Apr 22;69(5):566-574. doi: 10.4187/respcare.11376. Respir Care. 2024. PMID: 38649274 Free PMC article.
-
Patient Outcomes following Immediate Tracheostomy and Emergency Decompressive Craniectomy in the Same Setting.Int J Environ Res Public Health. 2022 Nov 26;19(23):15746. doi: 10.3390/ijerph192315746. Int J Environ Res Public Health. 2022. PMID: 36497820 Free PMC article. Review.
-
Traumatic brain injury: progress and challenges in prevention, clinical care, and research.Lancet Neurol. 2022 Nov;21(11):1004-1060. doi: 10.1016/S1474-4422(22)00309-X. Epub 2022 Sep 29. Lancet Neurol. 2022. PMID: 36183712 Free PMC article. Review.
References
-
- Rumbak M.J., Newton M., Truncale T., Schwartz S.W., Adams J.W., Hazard P.B. A prospective, randomized, study comparing early percutaneous dilational tracheotomy to prolonged translaryngeal intubation (delayed tracheotomy) in critically ill medical patients. Crit. Care Med. 2004;32:1689–1694. doi: 10.1097/01.CCM.0000134835.05161.B6. - DOI - PubMed
-
- Robba C., The CENTER-TBI ICU Participants and Investigators. Galimberti S., Graziano F., Wiegers E.J.A., Lingsma H.F., Iaquaniello C., Stocchetti N., Menon D., Citerio G. Tracheostomy practice and timing in traumatic brain-injured patients: A CENTER-TBI study. Intensiv. Care Med. 2020;46:983–994. doi: 10.1007/s00134-020-05935-5. - DOI - PMC - PubMed
Publication types
LinkOut - more resources
Full Text Sources