Early tracheotomy helps patients avoid ventilator-associated
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Surgically opening the windpipe, or trachea, within the first seven days of the start of mechanical ventilation decreases the time patients spend on ventilators, shortens their ICU stay, and lowers their risk of ventilator-associated pneumonia, according to a systematic review published in JAMA Otolaryngology-Head & Neck Surgery.

This study was aimed to compare the association of early (≤7 days) vs late tracheotomy with VAP and ventilator days in critically ill adults.

A search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, references of relevant articles, previous meta-analyses, and gray literature from inception to March 31, 2020, was performed. Primary outcomes included ventilator-associated pneumonia (VAP) and the duration of mechanical ventilation. Intensive care unit days and mortality (within the first 30 days of hospitalization) constituted secondary outcomes.

Seventeen unique trials with a cumulative 3145 patients were included in this review.

--Individuals undergoing early tracheotomy had a decrease in the occurrence of VAP and experienced more ventilator-free days.

--Early tracheotomy also resulted in fewer ICU days.

--Mortality was reported for 2445 patients and was comparable between groups.

In particular, Compared with a late tracheotomy, early intervention was associated with lower VAP rates and shorter duration of mechanical ventilation and ICU stay, but not with reduced short-term, all-cause mortality.

Source: https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2777173