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Effect of early tracheostomy on resource utilization and clinical outcomes in critically ill patients: meta-analysis of randomized controlled trials.
Szakmany, T; Russell, P; Wilkes, A R; Hall, J E.
Afiliación
  • Szakmany T; Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK Cwm Taf UHB, Royal Glamorgan Hospital, Llantrisant, UK szakmanyt1@cardiff.ac.uk.
  • Russell P; Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
  • Wilkes AR; Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
  • Hall JE; Cardiff Institute of Infection and Immunity, Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK.
Br J Anaesth ; 114(3): 396-405, 2015 Mar.
Article en En | MEDLINE | ID: mdl-25534400
BACKGROUND: Early tracheostomy may decrease the duration of mechanical ventilation, sedation exposure, and intensive care stay, possibly resulting in improved clinical outcomes, but the evidence is conflicting. METHODS: Systematic review and meta-analysis of randomized trials in patients allocated to tracheostomy within 10 days of start of mechanical ventilation was compared with placement of tracheostomy after 10 days if still required. Medline, EMBASE, the Cochrane Controlled Clinical Trials Register, and Google Scholar were searched for eligible trials. The co-primary outcomes were mortality within 60 days, and duration of mechanical ventilation, sedation, and intensive care unit stay. Secondary outcomes were the number of tracheostomy procedures performed, and incidence of ventilator-associated pneumonia (VAP). Outcomes are described as relative risk or weighted mean difference with 95% confidence intervals. RESULTS: Of note, 4482 publications were identified and 14 trials enrolling 2406 patients were included. Tracheostomy within 10 days was not associated with any difference in mortality [risk ratio (RR): 0.93 (0.83-1.05)]. There were no differences in duration of mechanical ventilation [-0.19 days (-1.13-0.75)], intensive care stay [-0.83 days (-2.05-0.40)], or incidence of VAP. However, duration of sedation was reduced in the early tracheostomy groups [-2.78 days (-3.68 to -1.88)]. More tracheostomies were performed in patients randomly assigned to receive early tracheostomy [RR: 2.53 (1.18-5.40)]. CONCLUSION: We found no evidence that early (within 10 days) tracheostomy reduced mortality, duration of mechanical ventilation, intensive care stay, or VAP. Early tracheostomy leads to more procedures and a shorter duration of sedation.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traqueostomía / Evaluación de Resultado en la Atención de Salud / Enfermedad Crítica / Recursos en Salud Tipo de estudio: Clinical_trials / Etiology_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Br J Anaesth Año: 2015 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Traqueostomía / Evaluación de Resultado en la Atención de Salud / Enfermedad Crítica / Recursos en Salud Tipo de estudio: Clinical_trials / Etiology_studies / Prognostic_studies / Systematic_reviews Límite: Humans Idioma: En Revista: Br J Anaesth Año: 2015 Tipo del documento: Article Pais de publicación: Reino Unido