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Outcomes comparison of early and late tracheostomy in severe traumatic brain injury patients: a meta-analysis

Abstract

Background: Tracheostomy reduces complications of extended endotracheal intubation and duration of mechanical ventilation and weaning in ventilated patients with severe traumatic brain injury (TBI) who often cannot maintain an adequate airway. The ideal timing of tracheostomy is still an ongoing debate. This study aimed to evaluate the outcome comparison of early and late tracheostomy on hospitalization outcomes in patients with severe TBI.

Methods: We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) method. The literature search was conducted in PubMed, Cochrane Library, and Medline until June 2023. Three reviewers independently assessed the methodological quality of the included studies using the Joanna-Briggs Institute (JBI) checklist. The Oxford Center for Evidence-Based Medicine assessed the evidence level of each study.

Results: Twelve studies were included in the meta-analysis, consisting of 2561 and 2690 patients in the early and late tracheostomy group, respectively. The early tracheostomy group was associated with reduced hospital length of stay (-10.16 days [95% CI, -13.68 to -6.65]) and ICU length of stay (-7.61 days [95% CI, -9.57 to -5.65]). Duration of mechanical ventilation (-7.26 days [95% CI, -11.72 to -2.80]) and incidence of pneumonia (0.65 [95% CI, 0.46 to 0.90]) are significantly lower in the early tracheostomy group. No significant difference in mortality rate, Glasgow outcome score (GOS) at the time of hospital discharge, and GOS at six months were found. Overall, studies have low-moderate risk of bias and good-moderate methodological quality.

Conclusion: An early tracheostomy is recommended to reduce the complication rate related to prolonged hospitalization and ventilation.

Keywords: early, late, outcome, tracheostomy, traumatic brain injury

How to Cite

Satyarsa, A. B. S., Wiyanjana, K. D. F., Brahmantya, I. B. Y., & Wardhana, D. P. W. (2024). Outcomes comparison of early and late tracheostomy in severe traumatic brain injury patients: a meta-analysis. Indonesian Journal of Neurosurgery, 7(1), 1–6. https://doi.org/10.15562/ijn.v7i1.255

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Agung Bagus Sista Satyarsa
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Kadek Dede Frisky Wiyanjana
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Ida Bagus Yorky Brahmantya
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Dewa Putu Wisnu Wardhana
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