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Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials

INTRODUCTION: The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy. METHODS: We searched PubMed and CENTRAL for randomized controlled trials that compared outcomes i...

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Autores principales: Hosokawa, Koji, Nishimura, Masaji, Egi, Moritoki, Vincent, Jean-Louis
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669624/
https://www.ncbi.nlm.nih.gov/pubmed/26635016
http://dx.doi.org/10.1186/s13054-015-1138-8
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author Hosokawa, Koji
Nishimura, Masaji
Egi, Moritoki
Vincent, Jean-Louis
author_facet Hosokawa, Koji
Nishimura, Masaji
Egi, Moritoki
Vincent, Jean-Louis
author_sort Hosokawa, Koji
collection PubMed
description INTRODUCTION: The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy. METHODS: We searched PubMed and CENTRAL for randomized controlled trials that compared outcomes in patients managed with early and late tracheotomy. A random-effects meta-analysis, combining data from three a priori-defined categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days), was performed to estimate the weighted mean difference (WMD) or odds ratio (OR). RESULTS: Of the 142 studies identified in the search, 12, including a total of 2,689 patients, met the inclusion criteria. The tracheotomy rate was significantly higher with early than with late tracheotomy (87 % versus 53 %, OR 16.1 (5.7-45.7); p <0.01). Early tracheotomy was associated with more ventilator-free days (WMD 2.12 (0.94, 3.30), p <0.01), a shorter ICU stay (WMD -5.14 (-9.99, -0.28), p = 0.04), a shorter duration of sedation (WMD -5.07 (-10.03, -0.10), p <0.05) and reduced long-term mortality (OR 0.83 (0.69-0.99), p = 0.04) than late tracheotomy. CONCLUSIONS: This updated meta-analysis reveals that early tracheotomy is associated with higher tracheotomy rates and better outcomes, including more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-1138-8) contains supplementary material, which is available to authorized users.
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spelling pubmed-46696242015-12-05 Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials Hosokawa, Koji Nishimura, Masaji Egi, Moritoki Vincent, Jean-Louis Crit Care Research INTRODUCTION: The optimal timing of tracheotomy in critically ill patients remains a topic of debate. We performed a systematic review to clarify the potential benefits of early versus late tracheotomy. METHODS: We searched PubMed and CENTRAL for randomized controlled trials that compared outcomes in patients managed with early and late tracheotomy. A random-effects meta-analysis, combining data from three a priori-defined categories of timing of tracheotomy (within 4 versus after 10 days, within 4 versus after 5 days, within 10 versus after 10 days), was performed to estimate the weighted mean difference (WMD) or odds ratio (OR). RESULTS: Of the 142 studies identified in the search, 12, including a total of 2,689 patients, met the inclusion criteria. The tracheotomy rate was significantly higher with early than with late tracheotomy (87 % versus 53 %, OR 16.1 (5.7-45.7); p <0.01). Early tracheotomy was associated with more ventilator-free days (WMD 2.12 (0.94, 3.30), p <0.01), a shorter ICU stay (WMD -5.14 (-9.99, -0.28), p = 0.04), a shorter duration of sedation (WMD -5.07 (-10.03, -0.10), p <0.05) and reduced long-term mortality (OR 0.83 (0.69-0.99), p = 0.04) than late tracheotomy. CONCLUSIONS: This updated meta-analysis reveals that early tracheotomy is associated with higher tracheotomy rates and better outcomes, including more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13054-015-1138-8) contains supplementary material, which is available to authorized users. BioMed Central 2015-12-04 2015 /pmc/articles/PMC4669624/ /pubmed/26635016 http://dx.doi.org/10.1186/s13054-015-1138-8 Text en © Hosokawa et al. 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Hosokawa, Koji
Nishimura, Masaji
Egi, Moritoki
Vincent, Jean-Louis
Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title_full Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title_fullStr Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title_full_unstemmed Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title_short Timing of tracheotomy in ICU patients: a systematic review of randomized controlled trials
title_sort timing of tracheotomy in icu patients: a systematic review of randomized controlled trials
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669624/
https://www.ncbi.nlm.nih.gov/pubmed/26635016
http://dx.doi.org/10.1186/s13054-015-1138-8
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