Optimizing the Time Point of Tracheostomy in Critical Illness Patients: Sooner Rather than Later

Background: Despite several meta-analysis had compared the benefits of early tracheostomy with late tracheostomy for patients who need mechanical ventilation, the optimal time point to apply TS is still vague. We defined three interval of TS time and aimed to find the best time point of TS placement that brings more benefits for patients. Methods: PubMed/Medline, China National Knowledge Infrastructure, ISI Web of Science and Cochrane library were searched for relevant trials. The interval of time was within three days (Super early tracheostomy, SET), three to seven days (Early tracheostomy, ET) and after seven days or prolonged incubation (Late tracheostomy, LT). A Bayesian network meta-analysis was performed, whereby the odds ratios (OR), random effect model and the 95% credible interval (CI) were applied to evaluate the event rates and endpoints, including mortality and pulmonary infection rates. Hierarchical analysis was performed to measure the prognosis of perioperative TS (PT). Findings: Seventeen trials, including 2,113 patients, were eligible for inclusion criteria and admitted to NMA (Network Meta-Analysis). The endpoints were incidence of mortality and pulmonary infection rates, the duration of mechanical ventilation and ICU stay were not available to calculate. Thirteen studies were connected to network for mortality rates and fourteen for pulmonary infection rates. SET showed lowest incidence of both endpoints and SURCA value presented SET served as best choice for both endpoints. Moreover, hierarchical analysis indicated that pulmonary infection and mortality rates were both lower in PT (perioperative TS) compared to those in SET. Interpretation: The optimal time point to perform TS is less than three days with endotracheal intubation. Furthermore, perioperative TS could bring more benefits when compared with TS within three days. Thus, it is sooner rather than later to perform TS for those potentially needs prolonged mechanical ventilation. Funding Statement: National Natural Science Foundation of China, Shanghai Key Medical Discipline Project, Program and Project of Pudong Health Bureau of Shanghai. Declaration of Interests: The authors have no competing interests. Ethics Approval Statement: The study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA statement).