Background: The optimal timing of tracheotomy in critically ill ventilated patients remains controversial.
Objectives: The objective of this meta-analysis was to assess tracheotomy timing for critically ill ventilated patients and determine the outcomes' reliability.
Methods: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials.
Results: Compared 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.
Conclusions: The 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.
Keywords: Critical illness; Early tracheotomy; Mechanical ventilation; Meta-analysis; Ventilator-associated pneumonia.
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