• Sabrina Araujo de Franca, Wagner M Tavares, SalinetAngela S MASMDepartment of Research of IPSPAC - Instituto Paulista de Saúde para Alta Complexidade, Santo Andre, São Paulo, Brazil.Division of Functional Neurosurgery, Institute of Neurology, University of São Paulo, São Paulo, São Paulo, Brazil., Wellingson S Paiva, and Manoel J Teixeira.
• Department of Research of IPSPAC - Instituto Paulista de Saúde para Alta Complexidade, Santo Andre, São Paulo, Brazil.
• Crit. Care Med. 2020 Apr 1; 48 (4): e325-e331.

ObjectivesTo elucidate the impact of early tracheostomy on hospitalization outcomes in patients with traumatic brain injury.Data SourcesLilacs, PubMed, and Cochrane databases were searched. The close-out date was August 8, 2018.Study SelectionStudies written in English, French, Spanish, or Portuguese with traumatic brain injury as the base trauma, clearly formulated question, patient's admission assessment, minimum follow-up during hospital stay, and minimum of two in-hospital outcomes were selected. Retrospective studies, prospective analyses, and case series were included. Studies without full reports or abstract, commentaries, editorials, and reviews were excluded.Data ExtractionThe study design, year, patient's demographics, mean time between admission and tracheostomy, neurologic assessment at admission, confirmed ventilator-assisted pneumonia, median ICU stay, median hospital stay, mortality rates, and ICU and hospital costs were extracted.Data SynthesisA total of 4,219 studies were retrieved and screened. Eight studies were selected for the systematic review; of these, seven were eligible for the meta-analysis. Comparative analyses were performed between the early tracheostomy and late tracheostomy groups. Mean time for early tracheostomy and late tracheostomy procedures was 5.59 days (SD, 0.34 d) and 11.8 days (SD, 0.81 d), respectively. Meta-analysis revealed that early tracheostomy was associated with shorter mechanical ventilation duration (-4.15 [95% CI, -6.30 to -1.99]) as well as ICU (-5.87 d [95% CI, -8.74 to -3.00 d]) and hospital (-6.68 d [95% CI, -8.03 to -5.32 d]) stay durations when compared with late tracheostomy. Early tracheostomy presented less risk difference for ventilator-associated pneumonia (risk difference, 0.78; 95% CI, 0.70-0.88). No statistical difference in mortality was found between the groups.ConclusionsThe findings from this meta-analysis suggest that early tracheostomy in severe traumatic brain injury patients contributes to a lower exposure to secondary insults and nosocomial adverse events, increasing the opportunity of patient's early rehabilitation and discharge.

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