Tracheostomy within four days of intubation tied to lower short-term mortality than tracheostomy on or after13 days

In the NMA for short-term mortality, there was a significant difference in the comparison results of tracheostomy performed ≤4 days from intubation and that performed ≥13 days from intubation (RR 0.67; very low certainty). The results derived from the NMA can provide clinical insight into the suitable timing for tracheostomy, which can aid in improving patient prognosis and decrease associated mortality and morbidity.

Tracheostomy is an invasive procedure for patients expected to need prolonged airway management or mechanical ventilation. There is no consensus on suitable timing for tracheostomy. A 2017 guideline for tracheostomy indicated that tracheostomy should be performed after 21 days of intubation; however, there is no strong evidence for this recommendation. There is a need for an NMA for comparing RCTs and grouping them according to tracheostomy timing, with both harmful and beneficial outcomes accounted for.

Against the above background, Yuki Kishihara, Jichi Medical University Saitama Medical Center, Omiya-ku, Saitama-shi, Saitama, Japan, and colleagues aimed to perform an NMA of multiple tracheostomy timings using data from RCTs to evaluate the effect on short-term mortality and adverse events.

For this purpose, the researchers searched the online databases for RCTs on mechanically ventilated patients aged ≥18 years on February 2, 2023. They classified the timing of tracheostomy into three groups based on the previous studies and clinical importance: ≤ 4 days, 5–12 days, and ≥ 13 days. The study's primary outcome was short-term mortality, defined as mortality at any reported time up to hospital discharge.

A total of eight randomized controlled trials were included. The results revealed no effect between ≤4 days versus 5–12 days and 5–12 days versus ≥ 13 days and a significant impact in ≤4 days vs. ≥ 13 days as follows: in ≤4 days vs. 5–12 days (RR, 0.79; very low certainty), ≤ 4 days vs. ≥ 13 days (RR, 0.67; very low certainty), and 5–12 days vs. ≥ 13 days (RR, 0.85; very low certainty).

To conclude, tracheostomy ≤4 days may lead to lower short-term mortality than tracheostomy ≥13 days.

Reference:

Kishihara, Y., Yasuda, H., Ozawa, H., Fukushima, F., Kashiura, M., & Moriya, T. (2023). Effects of tracheostomy timing in adult patients receiving mechanical ventilation: A systematic review and network meta-analysis. Journal of Critical Care, 77, 154299. https://doi.org/10.1016/j.jcrc.2023.154299