The impact of tracheostomy timing on the outcomes of patients with acute traumatic spinal cord injury: A systematic review and meta-analysis

Abstract

Background: Spinal cord injury (SCI) can cause serious respiratory problems. Cervical high-level injuries may result in diaphragm paralysis, necessitating tracheostomy to assist airway protection and facilitate breathing.

Methods: A comprehensive literature search of PubMed, Google Scholar, and Web of Science was performed for published studies comparing outcomes between early versus late tracheostomy in acute traumatic SCI patients.

Results: The initial search returned 1837 articles, after the final review, 17 studies with a total of 3853 patients were included in the meta-analysis. The mortality rate between early and late tracheostomy was not statistically significant (OR = 0.81, 95 % CI = [0.37, 1.78], P = 0.61). However, early tracheostomy was associated with reduced duration of mechanical ventilation (MD = - 10.58, 95 % CI = [-15.22, -5.95], P < 0.01), hospital length of stay (MD = - 8.50, 95 % CI = [-10.95, -6.05], P < 0.01), and ICU length of stay (MD = - 9.12, 95 % CI = [-12.20, -6.05], P < 0.01). Early tracheostomy was also associated with a lower incidence of pneumonia (OR = 0.68, 95 % CI = [0.51, 0.91], P < 0.01). Patients in the early tracheostomy group also experienced fewer tracheostomy-related complications (OR = 0.50, 95 % CI = [0.33, 0.75], P < 0.01).

Conclusion: In patients with acute traumatic SCI, early tracheostomy within seven days of injury, surgery, or intubation is associated with reduced duration of mechanical ventilation, and length of stay in the hospital and ICU. Early tracheostomy is also associated with a lower risk of tracheostomy-related complications.

Keywords: Critical care; Mechanical ventilation; SCI; Spinal cord injury; Tracheostomy.