Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis

Critical Care

Xiangming Fang¹  Baoli Cheng¹  Yumin Fang²  Yun Ji³  Libin Li³ 

[1] Department of Anesthesiology and Intensive Care, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China;Department of Intensive Care Unit, Suichang People’s Hospital, Lishui, Zhejiang, China;Department of Surgical Intensive Care Unit, the Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, Zhejiang, China;

关键词: COVID-19;    Intensive care unit;    Invasive mechanical ventilation;    Meta-analysis;    Respiratory failure;    Tracheostomy;   

DOI  :  10.1186/s13054-022-03904-6

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsWe 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.ResultsFourteen 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).ConclusionsThe 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.Trial registration The protocol was registered at INPLASY (INPLASY202180088).

【 授权许可】

CC BY