Department of ICU, The First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Harbin, China.
Department of ICU, Jiamusi Tumour Hospital, Jiamusi, China.
Heart Lung. 2019 Jan;48(1):46-54. doi: 10.1016/j.hrtlng.2018.09.005. Epub 2018 Oct 15.
The optimal timing of tracheotomy in critically ill ventilated patients remains controversial.
The objective of this meta-analysis was to assess tracheotomy timing for critically ill ventilated patients and determine the outcomes' reliability.
We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials.
Compared with late tracheotomy, early tracheotomy presented a lower incidence of ventilator-associated pneumonia (VAP), shorter duration of mechanical ventilation (MV), and shorter intensive care unit (ICU) stay. However, trial sequential analysis (TSA), a kind of cumulative meta-analysis, indicated that the evidence was unreliable and inconclusive.
The Findings suggest that early tracheotomy seems to be associated with a lower incidence of VAP, shorter duration of MV, shorter duration of sedation, and shorter ICU stay. However, the apparent benefits revealed in traditional meta-analysis contrast with the post-TSA results. More fully powered, randomized controlled trials focused on the outcomes of tracheotomy are highly warranted.
在重症机械通气患者中，气管切开术的最佳时机仍存在争议。
本荟萃分析旨在评估重症机械通气患者的气管切开时机，并确定结果的可靠性。
我们检索了 PubMed、Embase 和 Cochrane 图书馆中的随机对照试验。
与晚期气管切开相比，早期气管切开可降低呼吸机相关性肺炎（VAP）的发生率，缩短机械通气（MV）时间和重症监护病房（ICU）入住时间。然而，试验序贯分析（TSA），一种累积荟萃分析，表明证据不可靠和不确定。
研究结果表明，早期气管切开似乎与较低的 VAP 发生率、较短的 MV 时间、较短的镇静时间和较短的 ICU 入住时间相关。然而，传统荟萃分析中显示的明显益处与 TSA 后的结果相悖。需要开展更多的、有充分效能的、针对气管切开结局的随机对照试验。
