Tracheostomy With In Week Of Ventilator Support Lowers Rates
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Recent research reveals that tracheostomy placement no more than 7 days after ventilator support may lower the rates of ventilator-associated pneumonia and ventilator duration. The timing of tracheostomy placement in adult patients undergoing critical care remains unestablished.

The authors included randomized clinical trials comparing early and late tracheotomy with any of the primary outcomes, VAP or ventilator days. Two independent reviewers conducted all stages of the review. Seventeen unique trials with a cumulative 3145 patients were included in this review. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Pooled odds ratios (ORs) or the mean difference (MD) with 95% CIs were calculated using a random-effects model.

Primary outcomes included VAP and duration of mechanical ventilation. Intensive care unit days and mortality constituted secondary outcomes. The following key facts were seen:

~ 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.

Therefore, the authors concluded that "Compared with late tracheotomy, early intervention was associated with lower VAP rates and shorter durations of mechanical ventilation and ICU stay, but not with reduced short-term, all-cause mortality."

These findings have substantial clinical implications and may result in practice changes regarding the timing of tracheotomy in severely ill adults requiring mechanical ventilation, they further added.

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