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Effect of Early Versus Late Tracheostomy or Prolonged Intubation in Critically Ill Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis

Published on Feb 1, 2017in Neurocritical Care2.892
· DOI :10.1007/s12028-016-0297-z
Victoria A. McCredie7
Estimated H-index: 7
(Sunnybrook Health Sciences Centre),
Aziz S. Alali2
Estimated H-index: 2
(Sunnybrook Health Sciences Centre)
+ 4 AuthorsAvery B. Nathens60
Estimated H-index: 60
(Sunnybrook Health Sciences Centre)
Abstract
Background The optimal timing of tracheostomy placement in acutely brain-injured patients, who generally require endotracheal intubation for airway protection rather than respiratory failure, remains uncertain. We systematically reviewed trials comparing early tracheostomy to late tracheostomy or prolonged intubation in these patients.
  • References (56)
  • Citations (23)
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References56
Newest
#1Julian P T Higgins (UoB: University of Bristol)H-Index: 106
#2Sally Green (UCL: University College London)H-Index: 50
The Cochrane Handbook for Systematic Reviews of Interventions is the official document that describes in detail the process of preparing and maintaining Cochrane systematic reviews on the effects of healthcare interventions.
8,637 Citations
#1Liang Meng (Capital Medical University)H-Index: 1
#2Chunmei Wang (Capital Medical University)H-Index: 2
Last. Jian Zhang (Capital Medical University)H-Index: 1
view all 4 authors...
Background and Aims This study aims to compare the outcomes of early tracheostomy (ET) (≤10 days after translaryngeal intubation) with late tracheostomy (LT) (>10 days after translaryngeal intubation) in critically ill patients with prolonged mechanical ventilation (MV). Methods We searched PubMed, EMBASE and the Cochrane Library from inception to April 2014. We included all randomized controlled trials (RCTs), which compared ET with LT in critically ill patients. There was no language restricti...
22 CitationsSource
#1Joanna IntHout (Radboud University Nijmegen Medical Centre)H-Index: 21
#2John P. A. Ioannidis (Stanford University)H-Index: 157
Last. George F. Borm (Radboud University Nijmegen Medical Centre)H-Index: 50
view all 3 authors...
There is debate whether clinical trials with suboptimal power are justified and whether results from large studies are more reliable than the (combined) results of smaller trials. We quantified the error rates for evaluations based on single conventionally powered trials (80% or 90% power) versus evaluations based on the random-effects meta-analysis of a series of smaller trials. When a treatment was assumed to have no effect but heterogeneity was present, the error rates for a single trial were...
35 CitationsSource
#1Koji Hosokawa (ULB: Université libre de Bruxelles)H-Index: 13
#2Masaji Nishimura (University of Tokushima)H-Index: 24
Last. J-L Vincent (ULB: Université libre de Bruxelles)H-Index: 142
view all 4 authors...
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.
30 CitationsSource
#1Greg Arling (Purdue University)H-Index: 18
#2Susan OfnerH-Index: 14
Last. Dawn M. BravataH-Index: 23
view all 9 authors...
Background—Recovery after a stroke varies greatly between individuals and is reflected by wide variation in the use of institutional and home care services. This study sought to classify veterans according to their care trajectories in the 12 months after hospitalization for ischemic stroke. Methods and Results—The sample consisted of 3811 veterans hospitalized for ischemic stroke in Veterans Health Administration facilities in 2007. Three outcomes—nursing home care, home care, and mortality—wer...
6 CitationsSource
5 CitationsSource
#1Anuj B. Mehta (BU: Boston University)H-Index: 6
#2Sohera N. SyedaH-Index: 3
Last. Renda Soylemez WienerH-Index: 30
view all 6 authors...
Rationale: National trends in tracheostomy for mechanical ventilation (MV) patients are not well characterized.Objectives: To investigate trends in tracheostomy use, timing, and outcomes in the United States.Methods: We calculated estimates of tracheostomy use and outcomes from the National Inpatient Sample from 1993 to 2012. We used hierarchical models to determine factors associated with tracheostomy use among MV patients.Measurements and Main Results: We identified 1,352,432 adults who receiv...
32 CitationsSource
#1Tamas Szakmany (Cardiff University)H-Index: 18
#2Peter Russell (Cardiff University)H-Index: 1
Last. Judith Elizabeth Hall (Cardiff University)H-Index: 32
view all 4 authors...
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 Reg...
30 CitationsSource
#1Brenda Ng Andriolo (Cochrane Collaboration)H-Index: 6
#2Régis B AndrioloH-Index: 18
Last. Orsine Valente (UNIFESP: Federal University of São Paulo)H-Index: 5
view all 5 authors...
Background Long-term mechanical ventilation is the most common situation for which tracheostomy is indicated for patients in intensive care units (ICUs). 'Early' and 'late' tracheostomies are two categories of the timing of tracheostomy. Evidence on the advantages attributed to early versus late tracheostomy is somewhat conflicting but includes shorter hospital stays and lower mortality rates. Objectives To evaluate the effectiveness and safety of early (≤ 10 days after tracheal intubation) vers...
106 CitationsSource
#2Antoni MateuH-Index: 2
Last. Rafael MañezH-Index: 32
view all 8 authors...
Introduction We investigated the potential benefits of early tracheotomy performed before day eight of mechanical ventilation (MV) compared with late tracheotomy (from day 14 if it still indicated) in reducing mortality, days of MV, days of sedation and ICU length of stay (LOS).
17 CitationsSource
Cited By23
Newest
#1Hua-Wei Huang (Capital Medical University)H-Index: 2
#2Guobin Zhang (Capital Medical University)H-Index: 4
Last. Jian-Xin Zhou (Capital Medical University)H-Index: 4
view all 8 authors...
We evaluated the association between the timing of tracheostomy and clinical outcomes in patients with infratentorial lesions. We performed a retrospective observational cohort study in a neurosurgical intensive care unit (ICU) at a tertiary academic medical center from January 2014 to December 2018. Consecutive adult patients admitted to the ICU who underwent resection of infratentorial lesions as well as tracheostomy were included for analysis. Early tracheostomy was defined as performed on po...
Source
#1Silvia Hernández-Durán (GAU: University of Göttingen)H-Index: 2
#2Clara Salfelder (GAU: University of Göttingen)
Last. Christian von der Brelie (GAU: University of Göttingen)H-Index: 4
view all 7 authors...
OBJECTIVE Current evidence-based guidelines for the management of aneurysmal subarachnoid hemorrhage (aSAH) focus primarily on timing, modality and technique of aneurysm occlusion, and on prevention and treatment of delayed cerebral ischemia. Significant aspects of management in the intensive care unit (ICU) during the later course of aSAH such as ventilation and sedation (VST) remain unaddressed. aSAH patients present unique challenges not accounted for in general ICU recommendations and guidel...
Source
#1Naoki Yonezawa (UTokyo: University of Tokyo)
#2Taisuke Jo (UTokyo: University of Tokyo)H-Index: 12
Last. Hideo Yasunaga (UTokyo: University of Tokyo)H-Index: 33
view all 5 authors...
BACKGROUND: Patients with Guillain-Barre syndrome (GBS) who require mechanical ventilation (MV) are regarded as candidates for early tracheostomy because of the high risk of prolonged MV; however, the association between early tracheostomy and favorable outcomes in patients with GBS remains unclear. In this study, we evaluated the association between early tracheostomy and outcomes in mechanically ventilated patients with GBS. METHODS: This retrospective observational study included adult patien...
Source
#1Chiara Robba (University of Milano-Bicocca)H-Index: 1
#1Chiara Robba (University of Milano-Bicocca)H-Index: 4
Last. Giuseppe Citerio (University of Milano-Bicocca)H-Index: 38
view all 9 authors...
Indications and optimal timing for tracheostomy in traumatic brain-injured (TBI) patients are uncertain. This study aims to describe the patients’ characteristics, timing, and factors related to the decision to perform a tracheostomy and differences in strategies among different countries and assess the effect of the timing of tracheostomy on patients’ outcomes. We selected TBI patients from CENTER-TBI, a prospective observational longitudinal cohort study, with an intensive care unit stay ≥ 72 ...
3 CitationsSource
Source
#1Denise Battaglini (UniGe: University of Genoa)H-Index: 3
Last. C. Robba
view all 3 authors...
Neurocritically ill patients often receive mechanical ventilation. The lung and the brain can affect each other, thus increasing the risk of developing secondary damage, if not properly managed. Ventilator settings are not clear in this group of patients; traditionally, because of the risk of intracranial hypertension, high tidal volume and low levels of positive end-expiratory pressure (PEEP) are applied, whereas rescue strategies such as recruitment maneuvers, prone position, and extracorporea...
Source
#1Alexander A. FokinH-Index: 2
#2Joanna WycechH-Index: 2
Last. Ivan PuenteH-Index: 12
view all 7 authors...
Abstract Background Patients with blunt chest trauma with multiple rib fractures (RF) may require tracheostomy. The goal was to compare early (≤7 d) versus late (>7 d) tracheostomy patients and to analyze clinical outcomes, to determine which timing is more beneficial. Methods This retrospective review included 124 patients with RF admitted to trauma ICU at two level 1 trauma centers who underwent tracheostomy. Analyzed variables included age, gender, injury severity score, Glasgow Coma Scale, n...
Source
#1Matthew F. Sharrock (UNC: University of North Carolina at Chapel Hill)
Last. Kathryn Rosenblatt (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 2
view all 2 authors...
The depressant effects of an acute neurologic illness on airway, respiratory, and cardiovascular function can result in imminent peril to the patient and require expertise and judgment. However, airway management differs in that it also requires a range of manual skills. The emergence of new technology, principally video laryngoscopy, has improved intubation safety in the neurocritical care unit and has enhanced the skill set of intensivists. Recognizing a patient’s need for intubation, determin...
Source
#1Chiara Robba (UniGe: University of Genoa)H-Index: 4
#1Chiara Robba (UniGe: University of Genoa)H-Index: 15
Last. Paolo Pelosi (UniGe: University of Genoa)H-Index: 74
view all 5 authors...
Most patients with ischaemic stroke are managed on the ward or in specialty stroke units, but a significant number requires higher-acuity care and, consequently, admission to the intensive care unit. Mechanical ventilation is frequently performed in these patients due to swallowing dysfunction and airway or respiratory system compromise. Experimental studies have focused on stroke-induced immunosuppression and brain-lung crosstalk, leading to increased pulmonary damage and inflammation, as well ...
5 CitationsSource
#1Brian M. Sheehan (UCI: University of California, Irvine)H-Index: 1
#2Areg Grigorian (UCI: University of California, Irvine)H-Index: 3
Last. Jeffry Nahmias (UCI: University of California, Irvine)H-Index: 7
view all 8 authors...
Objectives:To determine whether, similar to adults, early tracheostomy in pediatric patients with severe traumatic brain injury (TBI) improves inhospital outcomes including ventilator days, intensi...
Source