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气管切开时机对机械通气患者的影响：一项随机对照试验的荟萃分析。

Effect of tracheotomy timing on patients receiving mechanical ventilation: A meta-analysis of randomized controlled trials.

机构信息

Department of Otolaryngology, Weifang People's Hospital, Weifang, Shan dong Province, China.

Department of Critical Care Medicine, Weifang People's Hospital, Weifang, Shan dong Province, China.

出版信息

PLoS One. 2024 Jul 23;19(7):e0307267. doi: 10.1371/journal.pone.0307267. eCollection 2024.

DOI:10.1371/journal.pone.0307267
PMID:39042629
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11265711/
Abstract

PURPOSE

We assessed the effects of tracheostomy timing (early vs. late) on outcomes among adult patients receiving mechanical ventilation.

METHODS

PubMed, Embase, Web of Science and Cochrane Library were searched to identify relevant RCTs of tracheotomy timing on patients receiving mechanical ventilation. Two reviewers independently screened the literature, extracted data. Outcomes in patients with early tracheostomy and late tracheostomy groups were compared and analyzed. Meta-analysis was performed using Stata14.0 and RevMan 5.4 software. This study is registered with PROSPERO (CRD42022360319).

RESULTS

Twenty-one RCTs were included in this Meta-analysis. The Meta-analysis indicated that early tracheotomy could significantly shorten the duration of mechanical ventilation (MD: -2.77; 95% CI -5.10~ -0.44; P = 0.02) and the length of ICU stay (MD: -6.36; 95% CI -9.84~ -2.88; P = 0.0003), but it did not significantly alter the all-cause mortality (RR 0.86; 95% CI 0.731.00; P = 0.06), the incidence of pneumonia (RR 0.86; 95% CI 0.741.01; P = 0.06), and length of hospital stay (MD: -3.24; 95% CI -7.99~ 1.52; P = 0.18).

CONCLUSION

In patients requiring mechanical ventilation, the tracheostomy performed at an earlier stage may shorten the duration of mechanical ventilation and the length of ICU stay but cannot significantly decrease the all-cause mortality and incidence of pneumonia.

摘要

目的

评估机械通气患者行气管切开术时机（早期与晚期）对结局的影响。

方法

检索 PubMed、Embase、Web of Science 和 Cochrane Library，以确定关于机械通气患者行气管切开术时机的随机对照试验。两位评审员独立筛选文献并提取数据。比较和分析早期气管切开组和晚期气管切开组患者的结局。使用 Stata14.0 和 RevMan 5.4 软件进行 Meta 分析。本研究已在 PROSPERO（CRD42022360319）注册。

结果

该 Meta 分析纳入了 21 项 RCT。Meta 分析表明，早期气管切开术可显著缩短机械通气时间（MD：-2.77；95%CI：-5.10-0.44；P=0.02）和 ICU 入住时间（MD：-6.36；95%CI：-9.84-2.88；P=0.0003），但对全因死亡率（RR：0.86；95%CI：0.731.00；P=0.06）、肺炎发生率（RR：0.86；95%CI：0.741.01；P=0.06）和住院时间（MD：-3.24；95%CI：-7.99~1.52；P=0.18）无显著影响。

结论

在需要机械通气的患者中，早期行气管切开术可能缩短机械通气时间和 ICU 入住时间，但不能显著降低全因死亡率和肺炎发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/729f/11265711/91f856efe332/pone.0307267.g015.jpg
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