Early versus late tracheostomy in people with multiple trauma

Area of Science:

• Critical Care Medicine
• Trauma Surgery
• Respiratory Therapy

Background:

• 83% of trauma patients require intensive care unit (ICU) admission, with many needing mechanical ventilation.
• Optimal timing for tracheostomy in multiple trauma patients remains unclear, despite its common use for prolonged ventilation.
• This review addresses the need for systematic assessment of early versus late tracheostomy in critically ill multiple trauma patients.

Purpose of the Study:

• To evaluate the benefits and harms of early tracheostomy compared to late tracheostomy in adults with multiple trauma.
• To systematically assess the impact of tracheostomy timing on critical outcomes in the ICU setting.

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, Web of Science, etc.) up to March 2024.
• Included randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) in critically ill adults with multiple trauma.
• Defined early tracheostomy as <10 days and late tracheostomy as ≥10 days post-intubation for main comparisons.

Main Results:

• One RCT (60 participants) and 22 NRSIs (44,811 participants) were included.
• Evidence from the RCT suggests little to no effect of early tracheostomy on mortality, ICU stay, or pneumonia, but certainty is very low.
• NRSI data also indicate uncertain effects on mortality and pneumonia, with some suggesting reduced ICU stay but increased in-hospital mortality; evidence certainty is consistently very low.

Conclusions:

• Early tracheostomy (<10 days) may have minimal impact on mortality, ICU stay, or pneumonia in multiple trauma patients, but evidence is highly uncertain.
• Data on quality of life and adverse events were unavailable; adjusted NRSI data suggest potential ICU stay reduction.
• High-quality studies are needed to standardize definitions, explore timing effects, and assess long-term outcomes for evidence-based clinical decision-making.