Efficacy of early tracheostomy in duration of respiratory support

ABSTRACT

Introduction: Progress in treatment of critical ill has as a result more frequent use of prolonged mechanical ventilation. If intubation is predicted to be long-term, a tracheostomy is often recommended.

Aim: The aim of the review was to investigate the efficacy of early tracheostomy in mechanical ventilation duration, compared to late tracheostomy.

Material and Method: International bibliography at online bibliographic database Pubmed research was conducted in order to identify all randomized or not clinical trials. For the selection of articles, were used combined criteria of inclusion and exclusion and time limitation. The prerequisite criteria for the selection of studies were: the English language, publication date (2009-2019), population who underwent tracheostomy and tracheostomy timing in relevance with mechanical ventilation duration. Studies that were excluded were those of which: the title of the article was not relevant to the subject of the systematic review, the sample was not about human species or concerned premature infants, tracheostomy cases were performed at emergencies (inability of endotracheal intubation).

Results: In this review 14 clinical trials were included. In 11 studies was detected that early tracheostomy had a positive effect on mechanical ventilation duration, while in 3 studies no statistically significant relationship was found between early tracheostomy and mechanical ventilation duration.

Conclusions: In patients with a high risk of mortality and morbidity, the concept of an early tracheostomy has significant benefits. However, better prognostic indicators are needed to further identify patients who may benefit from early tracheostomy during respiratory support.

Keywords: Critically Ill, early tracheostomy, late tracheostomy, tracheostomy time, tracheostomy timing