by Yun Ji, Yumin Fang, Baoli Cheng, Libin Li and Xiangming
Fang
Critical Care volume 26,
Article number: 40 (2022)
Background
The association of tracheostomy timing and clinical outcomes
in ventilated COVID-19 patients remains controversial. We performed a
meta-analysis to evaluate the impact of early tracheostomy compared to late
tracheostomy on COVID-19 patients’ outcomes.
Methods
We searched Medline, Embase, Cochrane, and Scopus database,
along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to
August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted
14 days or less after initiation of invasive mechanical ventilation (IMV).
Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU
stay, and overall mortality were the primary outcomes of the meta-analysis.
Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated
using a random-effects model.
Results
Fourteen studies with a cumulative 2371 tracheostomized
COVID-19 patients were included in this review. Early tracheostomy was
associated with significant reductions in duration of IMV (2098 patients; MD − 9.08 days,
95% CI − 10.91 to − 7.26 days, p < 0.01) and duration of ICU stay
(1224 patients; MD − 9.41 days, 95% CI − 12.36 to − 6.46 days, p < 0.01).
Mortality was reported for 2343 patients and was comparable between groups (OR
1.09, 95% CI 0.79–1.51, p = 0.59).
Conclusions
The results of this meta-analysis suggest that, compared
with late tracheostomy, early tracheostomy in COVID-19 patients was associated
with shorter duration of IMV and ICU stay without modifying the mortality rate.
These findings may have important implications to improve ICU availability
during the COVID-19 pandemic.
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