Chest
Original ResearchCritical CareThe Timing of Tracheotomy in Critically Ill Patients Undergoing Mechanical Ventilation: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Section snippets
Search Strategy
In reporting our results, we followed the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.16 Relevant articles in all languages were identified by searching PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Central Register of Controlled Trials, the National Research Register, the National Health Service Trusts Clinical Trials Register, and the Medical Research Council UK database (up to July 10, 2011). Electronic
Study Identification
The comprehensive search yielded a total of 1,212 relevant publications, and the abstracts were obtained for all citations (Fig 1). Seven RCTs with a total of 1,044 patients met the inclusion criteria.4, 14, 15, 20, 21, 22, 23 The Cohen κ statistic for agreement on study inclusion was 0.92.
Among the seven trials, three were conducted in North America,4, 14, 20 three in Europe,15, 22, 23 and one in North Africa.21 Three trials were multicenter studies.4, 15, 22 All trials were published in
Discussion
Our meta-analysis suggested that ET did not significantly reduce short- or long-term mortality or incidence of VAP in critically ill patients. In addition, the present study showed that ET was not associated with a markedly reduced duration of MV or sedation, shorter stay in ICU or hospital, or more complications.
Differences between the current meta-analysis and a previous one by Griffiths et al13 should be noted. In their meta-analysis,13 five trials with a total of 406 patients were included,
Conclusions
Our meta-analysis suggested that the timing of tracheotomy did not significantly alter important clinical outcomes in critically ill patients. A sensitive and validated formula to identify early those who need prolonged MV in the global increasing population of intubated critically ill patients is warranted. In addition, the duration of MV and sedation, as well as the long-term costs of ET in mechanically ventilated patients, should be evaluated in rigorously designed and adequately powered
Acknowledgments
Author contributions: Drs Li and Deng had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Wang: contributed to the definition of inclusion and exclusion criteria, electronic and manual search of the literature, drafting and revision of the manuscript, study design, and analysis and interpretation of the data.
Dr Wu: contributed to the definition of inclusion and exclusion criteria, electronic and manual
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Drs Wang, Wu, and Bo contributed equally to this article. Drs Deng and Li were considered senior authors.
Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).