The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis

Abstract

BackgroundThe optimal timing of tracheotomy in critically ill ventilated patients remains controversial. ObjectivesThe objective of this meta-analysis was to assess tracheotomy timing for critically ill ventilated patients and determine the outcomes’ reliability. MethodsWe searched PubMed, Embase, and the Cochrane Library for randomized controlled trials. ResultsCompared with late tracheotomy, early tracheotomy presented a lower incidence of ventilator-associated pneumonia (VAP), shorter duration of mechanical ventilation (MV), and shorter intensive care unit (ICU) stay. However, trial sequential analysis (TSA), a kind of cumulative meta-analysis, indicated that the evidence was unreliable and inconclusive. ConclusionsThe Findings suggest that early tracheotomy seems to be associated with a lower incidence of VAP, shorter duration of MV, shorter duration of sedation, and shorter ICU stay. However, the apparent benefits revealed in traditional meta-analysis contrast with the post-TSA results. More fully powered, randomized controlled trials focused on the outcomes of tracheotomy are highly warranted.