Meng Liang, Wang Chunmei, Li Jianxin, Zhang Jian
Intensive Care Unit of Vascular Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing, China.
Clin Respir J. 2016 Nov;10(6):684-692. doi: 10.1111/crj.12286. Epub 2015 Apr 6.
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).
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 restriction. Two authors extracted data and conducted a quality assessment. Meta-analyses using the fixed-effects or random-effects model were conducted for mortality, incidence of ventilator-associated pneumonia (VAP), duration of MV and sedation, length of intensive care unit (ICU) stay.
We enrolled 9 studies, in which a total of 2040 patients were randomized to either ET group (N = 1018) or LT group (N = 1022). ET might reduce the duration of sedation [weighted mean difference (WMD) = -5.99 days; 95% confidence intervals (CI) = -11.41 to -0.57 days; P = 0.03]. ET did not significantly alter the mortality [relative risk (RR) = 0.88; 95% CI = 0.76-1.00; P = 0.06], incidence of VAP (RR = 0.84; 95% CI = 0.66-1.08; P = 0.17), duration of MV (WMD = -4.46 days; 95% CI = -12.61 to 3.69 days; P = 0.28) and length of ICU stay (WMD = -7.57 days; 95% CI = -15.42 to 0.29 days; P = 0.06).
Our meta-analysis suggested that ET might be able to reduce the duration of sedation but did not significantly alter the mortality, incidence of VAP, duration of MV and length of ICU stay.
本研究旨在比较在需要长时间机械通气（MV）的危重症患者中，早期气管切开术（ET）（经喉插管后≤10天）与晚期气管切开术（LT）（经喉插管后>10天）的效果。
我们检索了从数据库建立至2014年4月的PubMed、EMBASE和Cochrane图书馆。我们纳入了所有比较危重症患者中ET与LT的随机对照试验（RCT）。没有语言限制。两名作者提取数据并进行质量评估。对死亡率、呼吸机相关性肺炎（VAP）发生率、MV持续时间和镇静时间、重症监护病房（ICU）住院时间进行固定效应或随机效应模型的Meta分析。
我们纳入了9项研究，共2040例患者被随机分为ET组（N = 1018）或LT组（N = 1022）。ET可能会缩短镇静时间[加权平均差（WMD）=-5.99天；95%置信区间（CI）=-11.41至-0.57天；P = 0.03]。ET未显著改变死亡率[相对危险度（RR）=0.88；95%CI = 0.76 - 1.00；P = 0.06]、VAP发生率（RR = 0.84；95%CI = 0.66 - 1.08；P = 0.17）、MV持续时间（WMD = -4.46天；95%CI = -12.61至3.69天；P = 0.28）和ICU住院时间（WMD = -7.57天；95%CI = -15.42至0.29天；P = 0.06）。
我们的Meta分析表明，ET可能能够缩短镇静时间，但未显著改变死亡率、VAP发生率、MV持续时间和ICU住院时间。
