Lu Qin, Xie Yonglin, Qi Xunchen, Li Xinwei, Yang Shuxu, Wang Yirong
Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, Zhejiang Province, China.
World Neurosurg. 2018 Apr;112:e324-e330. doi: 10.1016/j.wneu.2018.01.043. Epub 2018 Jan 11.
Tracheostomy has proven benefits for patients requiring prolonged mechanical ventilation. However, whether early tracheostomy (ET; <10 days after injury) can also improve outcomes in patients with severe traumatic brain injury (TBI) (Glasgow Coma Scale score ≤8) remains controversial. The aim of this study was to clarify this question.
We searched 4 databases (PubMed, Web of Science, Elsevier ScienceDirect, and Cochrane Library) for articles comparing the outcomes of ET with late tracheotomy or prolonged intubation in patients with severe TBI. Two reviewers were asked to record the major outcome data as follows: length of intensive care unit (ICU) stay, duration of mechanical ventilation, mortality, and incidence of pneumonia. Both random-effects and fixed-effects models were used.
Eight studies met our inclusion criteria, with a total of 797 patients in the ET group and 871 patients in the late tracheostomy or prolonged intubation (not-ET) group. A meta-analysis of these 8 studies suggested that ET could reduce the length of ICU stay (mean difference [MD], -3.08; 95% confidence interval [CI], -3.75 to -2.41), duration of mechanical ventilation (MD, -4.92; 95% CI, -6.82 to -3.02), length of hospital stay (MD, -4.79; 95% CI, -8.63 to -0.94), and incidence of pneumonia (odds ratio [OR], 0.64; 95% CI, 0.53-0.78), but seemed to be independent of mortality (OR, 1.25; 95% CI, 0.90-1.75).
The available evidence suggests that ET may reduce the length of ICU and hospital stays, duration of mechanical ventilation, and incidence of pneumonia in patients with severe TBI. Well-designed randomized controlled trials are needed to confirm these findings.
气管切开术已被证明对需要长期机械通气的患者有益。然而，早期气管切开术（ET；受伤后<10天）是否也能改善重度创伤性脑损伤（TBI）（格拉斯哥昏迷量表评分≤8）患者的预后仍存在争议。本研究的目的是阐明这个问题。
我们在4个数据库（PubMed、Web of Science、Elsevier ScienceDirect和Cochrane图书馆）中搜索了比较重度TBI患者中ET与晚期气管切开术或延长插管术预后的文章。两名审阅者被要求记录主要结局数据如下：重症监护病房（ICU）住院时间、机械通气持续时间、死亡率和肺炎发生率。使用随机效应模型和固定效应模型。
八项研究符合我们的纳入标准，ET组共有797例患者，晚期气管切开术或延长插管术（非ET）组有871例患者。对这八项研究的荟萃分析表明，ET可以缩短ICU住院时间（平均差[MD]，-3.08；95%置信区间[CI]，-3.75至-2.41）、机械通气持续时间（MD，-4.92；95%CI，-6.82至-3.02）、住院时间（MD，-4.79；95%CI，-8.63至-0.94）和肺炎发生率（比值比[OR]，0.64；95%CI，0.53 - 0.78），但似乎与死亡率无关（OR, 1.25；95%CI，0.90 - 1.75）。
现有证据表明，ET可能会缩短重度TBI患者的ICU和住院时间、机械通气持续时间以及肺炎发生率。需要设计良好的随机对照试验来证实这些发现。
