Abstract
Objectives
We aim to ascertain whether the benefit of early tracheostomy can be found in patients
with severe traumatic brain injury (TBI) and stroke and if the benefit will remain
considering distinct pathologies.
Data sources
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol,
a search through Lilacs, PubMed, and Cochrane databases was conducted.
Review methods
Included studies were those written in English, French, Spanish, or Portuguese, with
a formulated question, which compared outcomes between early and late trach (minimum
of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration
of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated
pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke
had minimum hospital stay follow-up, and as for severe TBI patients, they presented
Glasgow Coma Scale ≤8 at admission. Evaluated outcomes were the risk ratio (RR) of
VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of
MV, ICU LOS, and hospital LOS.
Results
The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively.
The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk
for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter
duration of MV (MD: −4.40 days [95% CI, −8.28, −0.53] p = 0.03), and shorter ICU (MD: −6.93
days [95% CI, −8.75, −5.11] p < 0.00001) and hospital LOS (MD: −7.05 days [95% CI, −8.27, −5.84]
p < 0.00001). The mortality rate did not demonstrate a statistical difference.
Conclusion
Early tracheostomy could optimise patient outcomes by patients' risk for VAP and decreasing
MV durationand ICU and hospital LOS.
Keywords
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Article info
Publication history
Published online: February 10, 2023
Accepted:
December 22,
2022
Received in revised form:
December 16,
2022
Received:
March 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
