A Meta-Analysis Of The Effect Of Early Tracheotomy On Ventilator-Associated Pneumonia And Mechanical Ventilation Time In ICU Patients

ObjectivesMeta analysis has been used in this study to evaluate effects of early tracheotomy on incidence of ventilator-associated pneumonia(VAP),mechanical ventilation time,mortality and length of stay in ICU.And this study has also explored effects of early tracheotomy on VAP incidence and mechanical ventilation time in patients with different diseases or those classified in different specialties of ICU,thus providing better evidence for clinical work.MethodsThis study has collected the randomized controlled trials before March 31,2021 on the impact of early tracheotomy on the prognosis of ICU patients with mechanical ventilation based on the retrieval results from PubMed database,Embase database,the Cochrane Library,China National Knowledge Infrastructure(CNKI)Database and Wanfang Database,as well as the manual search.The data concerned are first evaluated according to Cochrane Handbook(5.1.0)quality evaluation standard,and then go through Meta-analysis by RevMan 5.3.The combined effect of two classified variables(including mortality and VAP incidence)is based on the relative risk(RR)with 95%confidence interval(CI),while the numerical variables(including mechanical ventilation days and ICU hospital stay)derive from the weighted mean difference(WMD)with 95%confidence interval.Heterogeneity in the study is evaluated by I2 test and Q test.According to value of heterogeneity,a fixed effect model or a random effect model is used to analyze results,and then sensitivity analysis and subgroup analysis are further made to evaluate reliability of the research results.ResultsThis study includes a total of 19 RCT articles and a total of 2446 cases,including 1218 cases of early tracheotomy and 1228 cases of late tracheotomy.To start with,The Meta-analysis shows that compared with late tracheotomy,early tracheotomy can reduce the incidence of VAP(RR:0.78,95%CI:0.65～0.94,P=0.01).And subgroup analysis shows that early tracheotomy can reduce the incidence of VAP in patients with craniocerebral injury and trauma in ICU(RR:0.83,95%CI:0.73～0.94,P=0.004),and also reduce the incidence of VAP in patients with other diseases in ICU(RR:0.69,95%CI:0.49～0.96,P=0.03.Moreover,early tracheotomy can shorten the mechanical ventilation time(average difference:-5.25,95%CI:-9.09～-1.42,P=0.007),and subgroup analysis shows that early tracheotomy can shorten the mechanical ventilation days of patients with craniocerebral injury(average difference:-5.09,95%CI:-6.44～-3.74,P<0.00001).However,there is no effect on the mechanical ventilation time in the non-traumatic brain injury group(average difference:-6.03,95%CI:-12.46～0.40,P=0.07).In addition,early tracheotomy can shorten the hospitalization time in ICU(average difference:-6.16,95%CI:-9.06～-3.25,P<0.0001),and results of both subgroups show that early tracheotomy can shorten hospital stay in ICU.Furthermore,early tracheotomy has no effect on mortality of patients with mechanical ventilation in ICU(RR:0.88,95%CI:0.77～1.01,P=0.08).ConclusionsIt is concluded that early tracheotomy can reduce the incidence and mortality of VAP,and subgroup analysis shows that early tracheotomy has a more definite effect on reducing the incidence of VAP in patients with trauma and craniocerebral injury.Besides,early tracheotomy can shorten the mechanical ventilation time of patients with craniocerebral injury in ICU,but it has no effect on the mechanical ventilation time of patients with other diseases in ICU.Additionally,early tracheotomy can shorten the ICU stay of patients with mechanical ventilation.Apart from this,compared with late tracheotomy,early tracheotomy cannot reduce the mortality in ICU.