The timing of tracheotomy in critically ill patients undergoing mechanical ventilation: a systematic review and meta-analysis of randomized controlled trials

Chest. 2011 Dec;140(6):1456-1465. doi: 10.1378/chest.11-2024. Epub 2011 Sep 22.


Background: The objective of this study was to systematically review and quantitatively synthesize all randomized controlled trials (RCTs), comparing important outcomes in ventilated critically ill patients who received an early or late tracheotomy.

Methods: A systematic literature search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, the Cochrane Central Register of Controlled Trials, the National Research Register, the National Health Service Trusts Clinical Trials Register, and the Medical Research Council UK database was conducted using specific search terms. Eligible studies were RCTs that compared early tracheotomy (ET) with either late tracheotomy or prolonged endotracheal intubation in critically ill adult patients.

Results: Seven trials with 1,044 patients were analyzed. ET did not significantly reduce short-term mortality (relative risk [RR], 0.86; 95% CI, 0.65-1.13), long-term mortality (RR, 0.84; 95% CI, 0.68-1.04), or incidence of ventilator-associated pneumonia (RR, 0.94; 95% CI, 0.77-1.15) in critically ill patients. The timing of the tracheotomy was not associated with a markedly reduced duration of mechanical ventilation (MV) (weighted mean difference [WMD], -3.90 days; 95% CI, -9.71-1.91) or sedation (WMD, -7.09 days; 95% CI, -14.64-0.45), shorter stay in ICU (WMD, -6.93 days; 95% CI, -16.50-2.63) or hospital (WMD, 1.45 days; 95% CI, -5.31-8.22), or more complications (RR, 0.94; 95% CI, 0.66-1.34).

Conclusions: The present meta-analysis suggested that the timing of the tracheotomy did not significantly alter important clinical outcomes in critically ill patients. The duration of MV and sedation, as well as the long-term outcomes of ET in mechanically ventilated patients, should be evaluated in rigorously designed and adequately powered RCTs in the future.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Aged
  • Critical Care / methods
  • Critical Illness / mortality*
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Respiration, Artificial / methods
  • Respiration, Artificial / statistics & numerical data*
  • Risk Assessment
  • Time Factors
  • Tracheotomy / methods*
  • Tracheotomy / mortality
  • Treatment Outcome
  • Young Adult