Impact of Early Tracheostomy Versus Late or No Tracheostomy in Nonneurologically Injured Adult Patients: A Systematic Review and Meta-Analysis.

Autor:	Villemure-Poliquin N; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada.; Department of Ophtalmology, Otolaryngology and Head & Neck Surgery, Université Laval, Québec City, QC, Canada., Lessard Bonaventure P; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada.; Department of surgery, Division of neurosurgery, Université Laval, Québec City, QC, Canada., Costerousse O; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada., Rouleau-Bonenfant T; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada., Zarychanski R; Department of Internal Medicine, Sections of Critical Care Medicine, of Hematology, and of Medical Oncology, Rady Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.; Research Institute of Oncology and Hematology, CancerCare Manitoba, Winnipeg, MB, Canada., Lauzier F; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada.; Department of Medicine, Université Laval, Québec City, QC, Canada., Audet N; Department of Ophtalmology, Otolaryngology and Head & Neck Surgery, Université Laval, Québec City, QC, Canada., Moore L; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada.; Department of Preventive and Social Medicine, Université Laval, Québec City, QC, Canada., Gagnon MA; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada., Turgeon AF; CHU de Québec-Université Laval Research Center, Population Health and Optimal Health Practices Research Unit (Trauma-Emergency-Critical Care Medicine), Université Laval, Québec City, QC, Canada.; Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, QC, Canada.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2023 Feb 01; Vol. 51 (2), pp. 310-318. Date of Electronic Publication: 2022 Dec 07.
DOI:	10.1097/CCM.0000000000005699
Abstrakt:	Objective: The optimal timing of tracheostomy in nonneurologically injured mechanically ventilated critically ill adult patients is uncertain. We conducted a systematic review of randomized controlled trials to evaluate the effect of early versus late tracheostomy or prolonged intubation in this population. Data Sources: We searched MEDLINE, Embase, CENTRAL, CINAHL, and Web of science databases for randomized controlled trials comparing early tracheostomy (<10 d of intubation) with late tracheostomy or prolonged intubation in adults. Data Selection: We selected trials comparing early tracheostomy (defined as being performed less than 10 d after intubation) with late tracheostomy (performed on or after the 10th day of intubation) or prolonged intubation and no tracheostomy in nonneurologically injured patients. The primary outcome was overall mortality. Secondary outcomes included ventilator-associated pneumonia, duration of mechanical ventilation, ICU, and hospital length of stay. Data Extraction: Two reviewers screened citations, extracted data, assessed the risk of bias, and classification of Grading of Recommendations, Assessment, Development, and Evaluation independently. Data Synthesis: Our search strategy yielded 8,275 citations, from which nine trials (n = 2,457) were included. We did not observe an effect on the overall mortality of early tracheostomy compared with late tracheostomy or prolonged intubation (risk ratio, 0.91, 95% CI, 0.82-1.01; I2 = 18%). Our results were consistent in all subgroup analyses. No differences were observed in ICU and hospital length of stay, duration of mechanical ventilation, incidence of ventilator-acquired pneumonia, and complications. Our trial sequential analysis showed that our primary analysis on mortality was likely underpowered. Conclusion: In our systematic review, we observed that early tracheostomy, as compared with late tracheostomy or prolonged intubation, was not associated with a reduction in overall mortality. However, we cannot exclude a clinically relevant reduction in mortality considering the level of certainty of the evidence. A well-designed trial is needed to answer this important clinical question. Competing Interests: Drs. Villemure-Poliquin and Lessard Bonaventure are recipients of training awards from the Fonds de la Recherche du Québec—Santé (FRQS). Dr. Lauzier is a recipient of a research salary support award from FRQS. Dr. Zarychanski is supported by the Lyonel G. Israels Research Chair in Hematology, University of Manitoba. Dr. Turgeon is the chairholder of the Canada Research Chair in Critical Care Neurology and Trauma. Dr. Audet disclosed that she is a consultant for Merck Canada. Dr. Gagnon disclosed work for hire. Dr. Turgeon’s institution received funding from the Canadian Institutes of Health Research. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu