by Abdelaal Ahmed Mahmoud M. Alkhatip, Ahmed; Younis,
Mohamed; Jamshidi, Negar; Hussein, Hazem A; Farag, Ehab; Hamza, Mohamed K.;
Bahr, Mahmoud H.; Goda Ahmed, Ahmed; Sallam, Amr M.; Mohamed, Hassan; Elayashy,
Mohamed; Hosny, Hisham; Yassin, Hany M.; Abdelhaq, Mohamed; Elramely, Mohamed
A.; Reeves, David; Mills, Kerry E.; Kamal, Ahmed M.; Zakaria, Dina
Critical Care Medicine: February 2020
- Volume 48 - Issue 2 - p 233-240
Objectives:
Tracheostomy is a very common clinical intervention in critically ill adult
patients. The indications for tracheostomy procedures in pediatric patients
with complex conditions have increased dramatically in recent years, but there
are currently no guidelines on the optimal timing of tracheostomy in pediatric
patients undergoing prolonged ventilation.
Data Sources: We performed a systematic search of the existing
literature in MEDLINE via PubMed and Embase databases and the Cochrane Library
to identify clinical trials, observational studies, and cohort studies that
compare early and late tracheostomy in children. The date of the last search was
August 27, 2018. Included articles were subjected to manual searching.
Study Selection:
Studies in mechanically ventilated children that compared early with late
tracheostomy were included.
Data Extraction:
Data were extracted into a spreadsheet and copied into Review Manager 5.3 (The
Cochrane Collaboration, Copenhagen, Denmark).
Data Synthesis:
Data were meta-analyzed using an inverse variance, random effects model.
Continuous outcomes were calculated as mean differences with 95% CIs, and
dichotomous outcomes were calculated as Mantel-Haenszel risk ratios with 95%
CIs. We included eight studies (10 study arms). These studies were all
retrospective cohort studies. Early tracheostomy was associated with
significant reductions in mortality, days on mechanical ventilation, and length
of intensive care and total hospital stay, although the lack of randomized,
controlled trials limits the validity of these findings. Although variance was
imputed for some studies, these conclusions did not change after removing these
studies from the analysis.
Conclusions: In
children on mechanical ventilation, early tracheostomy may improve important
medical outcomes. However, our data demonstrate the urgent need for
high-quality, randomized controlled trials in the pediatric population.
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