Keywords
Mechanical ventilation
Intensive care unit
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Abstract
Objective: To update and evaluate, through a systematic review and meta-analysis, the effects of early versus late tracheostomy on clinical outcomes in critically ill adult patients undergoing invasive mechanical ventilation. Methods: A systematic review was conducted according to PRISMA 2020 recommendations and registered in PROSPERO (CRD420251178979). Randomized controlled trials comparing early and late tracheostomy in mechanically ventilated adults were included. Searches were performed in PubMed, Embase, and Cochrane Library databases. Outcomes analyzed included overall mortality, 30-day mortality, duration of mechanical ventilation, length of stay in the intensive care unit, ventilator-associated pneumonia, and laryngeal complications. Random-effects models were used for statistical analysis. Results: Eighteen randomized controlled trials were included, totaling 3,656 patients. Early tracheostomy was associated with a lower incidence of laryngeal complications and reduced overall mortality, particularly among non-neurocritical patients. No significant overall reduction was observed in duration of mechanical ventilation or ventilator-associated pneumonia. Final considerations: Early tracheostomy does not demonstrate uniform benefits in the general critically ill population. However, specific subgroups may experience clinically relevant advantages, supporting an individualized decision-making approach.
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