Is early tracheostomy better for severe traumatic brain injury? A meta-analysis.

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Is early tracheostomy better for severe traumatic brain injury? A meta-analysis.

World Neurosurg. 2018 Jan 11;:

Authors: Lu Q, Xie Y, Qi X, Li X, Yang S, Wang Y

Abstract
OBJECTIVE: Tracheotomy have been proven to be benefit for the patients requiring prolonged mechanical ventilation. However, whether early tracheotomy (less than 10 days) could also improve the outcome of severe traumatic brain injury (TBI) patient (GCS≤8) remains controversial. The aim of this study was trying to clarify this question.
METHODS: We searched four databases (PubMed, Web of Science, Elsevier and Cochrane Library) for articles comparing the outcome of early tracheostomy with late tracheostomy or prolonged intubation on the severe TBI patients. Two reviewers were asked to record the major outcome data as follows, intensive care unit (ICU) stay, mechanical ventilation duration, mortality and pneumonia rate. Both random-effects and fix-effects models were used.
RESULTS: Total eight studies met our inclusion criteria with 797 patients in early tracheotomy (ET) group and 871 patients in late tracheostomy or prolonged intubation(not-ET) group. Meta-analysis of eight eligible studies suggested that early tracheostomy could reduce the length of ICU stay (MD -3.08, 95%CI, -3.75, -2.41), the duration of mechanical ventilation (MD -4.92, 95 % CI, -6.82, -3.02), the length of hospital stay (MD -4.79, 95 % CI, -8.63, -0.94) and the incidence of pneumonia (OR 0.64, 95 % CI, 0.53, 0.78), But it seemed to be independent from the rate of mortality (OR 1.25, 95 % CI, 0.90, 1.75).
CONCLUSIONS: Available evidences suggest that early tracheotomy may reduce the ICU and hospital stay, the mechanical ventilation duration and the pneumonia incidence rate. Well-designed randomized controlled trials are needed to further confirm.

PMID: 29337171 [PubMed - as supplied by publisher]

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