الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 122 |  |  |
| | | from | 122 | | |
Abstract
Tracheostomy is creating a stoma at the surface of the skin leading into
the trachea. It is a frequently performed procedure in about 24% of ICU
patients as it has many advantages over prolonged endotracheal intubation as:
reducing oropharyngeal and laryngeal trauma, reducing work of breathing by
decreasing airway dead space and lowering the airway resistance, improving
pulmonary secretion clearance, reducing the use of sedation and decreasing
the duration of mechanical ventilation and consequently length of ICU and
hospital stay.
Tracheostomy is indicated in severe upper airway obstruction, patients
expected to require prolonged mechanical ventilation for at least two weeks,
clearing secretions from the airways through the tracheostomy tube or as a
part of another procedure. However, prolonged endotracheal intubation is the
most common indication for tracheostomy.
The optimal timing of tracheostomy in patients requiring prolonged
endotracheal intubation is still a debate despite its advantages. The National
Association of Medical Directors of Respiratory Care in 1989 stated that
tracheostomy is indicated if mechanical ventilation is to be continued for more
than 21 days while patients requiring mechanical ventilation for less than 10
days are candidates for endotracheal intubation. Other authors recommended
early tracheostomy while others mentioned that the evidence of the benefits
of tracheostomy over endotracheal intubation is insufficient.
This meta-analysis aimed to evaluate the appropriate timing of
tracheostomy in patients with prolonged intubation regarding the incidence of
Summary
91
hospital-acquired pneumonia, incidence of mortality, ICU length of stay and
duration of mechanical ventilation.
Forty-three studies with 222641 patients were included in this metaanalysis,
41 studies in adult age group including 222501 patients and 2 studies
in paediatric age group including 140 patients. To overcome the heterogeneity
between different studies, a sensitivity analysis was conducted dividing the
studies in adult age group into three groups according to the methodology of
determining the timing of early tracheostomy into studies that considered
early tracheostomy within the first 7 days of endotracheal intubation, studies
that considered early tracheostomy within 14 days of intubation and studies
that considered early tracheostomy within 21 days of intubation.
We concluded that in adult patients with prolonged intubation, early
tracheostomy is significantly associated with reduction in incidence of hospitalacquired
pneumonia, incidence of mortality, duration on mechanical
ventilation and length of stay in ICU and that studies that considered
tracheostomy to be early if performed within the first 7 days of intubation had
better results than studies that considered early tracheostomy is that done
within 14 days or 21 days of endotracheal intubation. While in paediatric age
group, early tracheostomy is associated with deceased duration of mechanical
ventilation and length of stay in ICU but does not affect the incidence of
hospital-acquired pneumonia.