Early tracheostomy in severe traumatic brain injury: an umbrella systematic review

Tracheostomy is an option to ensure airway safety in patients with severe traumatic brain injury. However, the optimal timing for tracheostomy remains unclear based on current evidence.

Umbrella systematic review to determine the effectiveness of early tracheostomy in TBI.

PubMed, Embase, Scopus, Web of Science, Lilacs, Cochrane, Open Grey, and clinical trials.

Meta-analysis of early tracheostomy in severe TBI patients.

if there was no data regarding the time of death or the follow-up period.

Selection, risk of bias evaluation, and data extraction were performed by two independent authors.

Four meta-analyses were included from 5673 initial records, and a new meta-analysis was performed from data obtained in primary studies. The evidence included in this umbrella review showed that early tracheostomy reduced ICU (MD = -5.69 days; 95% CI [-7.78, -3.59]) and Hospital (MD = -3.53 days; 95% CI [-4.44, -2.62]) length of stay, time in mechanical ventilation (MD = -5.08; 95% CI [-7.12, -3.05]) and risk of ventilator associated pneumonia (RR = 0.78; 95% CI [0.70, 0.86],). These studies cannot determine the effectiveness of early tracheostomy on mortality (RR = 1.32; 95% CI [0.89, 1.96],) or neurological prognosis.

This umbrella review suggests that early tracheostomy is effective in reducing ICU and Hospital length of stay, time in mechanical ventilation, and ventilator-associated pneumonia.

202280096.