Effect of early versus late tracheostomy on mortality and length of stay of critically ill patients receiving mechanical ventilation

Abstract

Overview: Tracheostomy procedures are frequently performed in intensive care units (ICU) for the gradual weaning of mechanical ventilation for patients necessitating extended respiratory support. The timing of tracheostomy insertion affects the ICU length of stay (LOS), duration of hospitalization, and mortality rates. This dissertation evaluates the effect of early versus late tracheostomy insertion on hospital LOS and mortality rates. The Research Question: This dissertation focused on the following Population-InterventionComparison-Outcome (PICO) question: In critically ill patients requiring prolonged mechanical ventilation (P), does an early tracheostomy (I) lead to shorter hospital stays and lower mortality rates (O) when compared to a late tracheostomy (C)? Method: Key terms relevant to the research question such as ‘prolonged mechanical ventilation’, ‘early tracheostomy’, ‘late tracheostomy’, ‘hospital length of stay’, and ‘Intensive Care Unit stay’ were identified and combined with Boolean operators, search tools and limiters. The search was conducted using health-related platforms (EBSCO, PubMed, and SAGE Journals), and an internet search engine (Google Scholar). Eligibility criteria were applied, including full-text articles written in English and published in the last ten years, which were either systematic reviews (SRs), meta-analyses, or randomized controlled trials (RCTs) that compared early versus late tracheostomy in critically ill adult patients. The PRISMA (2020) checklist screened and excluded non-related articles. As a result, five studies were retrieved, including one meta-analysis, three SRs with meta-analyses, and one RCT. The ‘Critical Appraisal Skills Program’ (CASP) tools for systematic reviews and randomized controlled trials were utilized for the critical appraisal. Results: Four SRs/meta-analyses demonstrated a reduced LOS with early tracheostomy insertion. The RCT did not find a difference in early vs. late tracheostomy for the duration of stay. All five key studies did not find a difference in mortality rate between early vs. late tracheostomy insertion. Conclusion: Although the findings of the four SRs/meta-analyses indicate a reduced LOS in the early tracheostomy groups, it remains challenging to draw definitive conclusions. Tracheostomy insertion timings should be consistent in future research to reduce heterogeneity and facilitate comparison analysis. Implications and Recommendations: To standardise patient outcomes, procedures must be reviewed and modified based on current evidence-based practices. Future research may involve more localised studies, greater sample numbers, and tracheostomy insertion time frames to aggregate and compare data.