Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Jul 28;10(15):3319.
doi: 10.3390/jcm10153319.

Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis

Affiliations
Review

Early vs. Late Tracheostomy in Patients with Traumatic Brain Injury: Systematic Review and Meta-Analysis

Annachiara Marra et al. J Clin Med. .

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.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
PRISMA 2009 Flow Diagram.
Figure 2
Figure 2
(A): Forest plot for incidence of pneumonia; (B): Forest plot for incidence of pneumonia in RCTs.
Figure 3
Figure 3
Forest plot for ICU length of stay.
Figure 4
Figure 4
Forest plot for hospital length of stay.
Figure 5
Figure 5
Forest plot for duration of mechanical ventilation.
Figure 6
Figure 6
Forest plot for mortality in included studies.

Similar articles

Cited by

  • Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis.
    Azari Jafari A, Mirmoeeni S, Momtaz D, Kotzur T, Murtha G, Garcia C, Moran M, Martinez P, Chen K, Krishnakumar H, Seifi A. Azari Jafari A, et al. 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.
    Yan A, Torpey A, Morrisroe E, Andraous W, Costa A, Bergese S. Yan A, et al. 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.
    Eskildsen SJ, Hansen CA, Kallemose T, Curtis DJ, Wessel I, Poulsen I. Eskildsen SJ, et al. 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.
    Kumar R, Zenian MS, Maeng TY, Fadzil F, Mohd Azli AN. Kumar R, et al. 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.
    Maas AIR, Menon DK, Manley GT, Abrams M, Åkerlund C, Andelic N, Aries M, Bashford T, Bell MJ, Bodien YG, Brett BL, Büki A, Chesnut RM, Citerio G, Clark D, Clasby B, Cooper DJ, Czeiter E, Czosnyka M, Dams-O'Connor K, De Keyser V, Diaz-Arrastia R, Ercole A, van Essen TA, Falvey É, Ferguson AR, Figaji A, Fitzgerald M, Foreman B, Gantner D, Gao G, Giacino J, Gravesteijn B, Guiza F, Gupta D, Gurnell M, Haagsma JA, Hammond FM, Hawryluk G, Hutchinson P, van der Jagt M, Jain S, Jain S, Jiang JY, Kent H, Kolias A, Kompanje EJO, Lecky F, Lingsma HF, Maegele M, Majdan M, Markowitz A, McCrea M, Meyfroidt G, Mikolić A, Mondello S, Mukherjee P, Nelson D, Nelson LD, Newcombe V, Okonkwo D, Orešič M, Peul W, Pisică D, Polinder S, Ponsford J, Puybasset L, Raj R, Robba C, Røe C, Rosand J, Schueler P, Sharp DJ, Smielewski P, Stein MB, von Steinbüchel N, Stewart W, Steyerberg EW, Stocchetti N, Temkin N, Tenovuo O, Theadom A, Thomas I, Espin AT, Turgeon AF, Unterberg A, Van Praag D, van Veen E, Verheyden J, Vyvere TV, Wang KKW, Wiegers EJA, Williams WH, Wilson L, Wisniewski SR, Younsi A, Yue JK, Yuh EL, Zeiler FA, Zeldovich M, Zemek R; InTBIR Participants and Investigators. Maas AIR, et al. 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

    1. De Franca S.A., Tavares W.M., Salinet A.S.M., Paiva W., Teixeira M.J. Early Tracheostomy in Severe Traumatic Brain Injury Patients: A meta-analysis and comparison with late tracheostomy. Crit. Care Med. 2020;48:e325–e331. doi: 10.1097/CCM.0000000000004239. - DOI - PubMed
    1. Dewan M.C., Rattani A., Gupta S., Baticulon R., Hung Y.-C., Punchak M., Agrawal A., Adeleye A.O., Shrime M.G., Rubiano A.M., et al. Estimating the global incidence of traumatic brain injury. J. Neurosurg. 2019;130:1080–1097. doi: 10.3171/2017.10.JNS17352. - DOI - PubMed
    1. Lu Q., Xie Y., Qi X., Li X., Yang S., Wang Y. Is Early Tracheostomy Better for Severe Traumatic Brain Injury? A Meta-Analysis. World Neurosurg. 2018;112:e324–e330. doi: 10.1016/j.wneu.2018.01.043. - DOI - PubMed
    1. 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
    1. 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

LinkOut - more resources