Early tracheostomy versus late tracheostomy in severe traumatic brain injury or stroke: A systematic review and meta-analysis

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art_TAVARES_Early_tracheostomy_versus_late_tracheostomy_in_severe_traumatic_2023.PDF (1.51 MB)
Citações na Scopus
1
Tipo de produção
article
Data de publicação
2023
DOI
Scopus
Web of Science
PubMed
Título da Revista
ISSN da Revista
Título do Volume
Editora
ELSEVIER SCIENCE INC
Autores
FRANCA, Sabrina Araujo de
Citação
AUSTRALIAN CRITICAL CARE, v.36, n.6, p.1110-1116, 2023
Projetos de Pesquisa
Unidades Organizacionais
Fascículo
Resumo
Objectives: We aim to ascertain whether the benefit of early tracheostomy can be found in patients with severe traumatic brain injury (TBI) and stroke and if the benefit will remain considering distinct pathologies.Data sources: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, a search through Lilacs, PubMed, and Cochrane databases was conducted. Review methods: Included studies were those written in English, French, Spanish, or Portuguese, with a formulated question, which compared outcomes between early and late trach (minimum of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke had minimum hospital stay follow-up, and as for severe TBI patients, they presented Glasgow Coma Scale <8 at admission. Evaluated outcomes were the risk ratio (RR) of VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of MV, ICU LOS, and hospital LOS.Results: The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively. The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter duration of MV (MD:-4.40 days [95% CI,-8.28,-0.53] p = 0.03), and shorter ICU (MD:-6.93 days [95% CI,-8.75,-5.11] p < 0.00001) and hospital LOS (MD:-7.05 days [95% CI,-8.27,-5.84] p < 0.00001). The mortality rate did not demonstrate a statistical difference.Conclusion: Early tracheostomy could optimise patient outcomes by patients' risk for VAP and decreasing MV durationand ICU and hospital LOS.(c) 2023 Australian College of Critical Care Nurses Ltd.
Palavras-chave
Bene fits, Early medical intervention, Outcome, Severe brain injury, Stroke, TBI, Tracheostomy
URI
https://observatorio.fm.usp.br/handle/OPI/57977
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Coleções
Artigos e Materiais de Revistas Científicas - FM/MNE
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - LIM/45
Artigos e Materiais de Revistas Científicas - LIM/62
Artigos e Materiais de Revistas Científicas - ODS/03