Is Early Tracheostomy Better for Severe Traumatic Brain Injury? A Meta-Analysis.

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.