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

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