Early vs Late Tracheotomy in the ICU

Summary by Boris Ladyzhensky MD, 02.10.22

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669624/

Timing of Tracheotomy in ICU Patients: A Systemic Review of Randomized Controlled Trials

Hosokawa et al. Critical Care (2015) 19:424

This is a systematic review which analyzed a total of 12 selected RCTs that compared outcomes of early (<10d) vs late (>10d) tracheotomy.

• This updated meta-analysis reveals that early tracheotomy is associated with:

  • Higher tracheotomy rates

  • Better outcomes --> more ventilator-free days, shorter ICU stays, less sedation, and reduced long-term mortality, compared to late tracheotomy.

• Additional notes:

  • When comparing early vs late tracheotomy --> No significant difference in short-term mortality, risk of acquired pneumonia, or duration of mechanical ventilation (only ventilator free days differed).

  • The neurologic injuries (head injury, spinal cord injury, stroke) population was not addressed in detail, however this is indeed a population that, as we see in our daily clinical practice, benefits from early tracheotomy.

  • The assessment restricted to groups of studies with different time cutoffs did not provide enough information to be able to draw conclusions about differences between very early (within 4 days) and moderately early (within 10 days) tracheotomy.