SynthesisBMJ open respiratory research2025
Early versus late tracheostomy in critically ill patients: an umbrella review of systematic reviews of randomised clinical trials with meta-analyses and trial sequential analysis.
Synthesis in BMJ open respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Clinical Determinants of 90-Day Mortality After Tracheostomy in Critically Ill Patients: A Multicenter Retrospective Cohort Study.Medicina (Kaunas, Lithuania) · 2026Article
- Early (≤10 Days) vs. Late (>10 Days) Tracheostomy in the Intensive Care Unit: Impact on Discontinuation of Sedation and Mechanical Ventilation.Life (Basel, Switzerland) · 2026Article
- Article
- Comparison between Tracheostomy and No Tracheostomy on the Incidence of Ventilator-Associated Pneumonia (VAP) Using the Modified Clinical Pulmonary Infection Score (MCPIS): A Prospective Cohort Study.Medical journal of the Islamic Republic of Iran · 2025Article
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThis study conducts an umbrella review of systematic reviews and meta-analyses of randomised clinical trials (RCTs) to evaluate the outcomes of early vs late tracheostomy, focusing on potential biases and the coherence of the evidence. DATA SOURCES: Searches were conducted in the MEDLINE, Embase, Lilacs and Cochrane Library databases up to November 2024. STUDY SELECTION: Our analysis included studies meeting the following criteria: Population: patients admitted to intensive care units and receiving mechanical ventilation.
interventionearly tracheostomy, as defined by the respective study. CONTROL: late tracheostomy, as defined by the respective study. PRIMARY OUTCOMES: mortality and incidence of ventilator-associated pneumonia (VAP). STUDY
designsystematic reviews and meta-analysis of RCTs. DATA EXTRACTION: Two reviewers performed article inclusion, with consensus resolution by a third reviewer in case of disagreement. The quality of studies was assessed using the AMSTAR 2 tool. A random-effects meta-analysis was conducted with an algorithm based on the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) classification DATA SYNTHESIS: Out of 7664 articles identified, 60 articles were considered eligible for full-text reading, and 22 were included in the review. Most studies were rated as critically low quality. Our meta-analysis update with 19 RCTs showed a decrease in VAP (OR 0.65 (0.47 to 0.89), 95% CI; p=0.007) among early tracheostomy patients compared with late tracheostomy patients, but no significant difference in terms of mortality (OR 0.85 (0.70 to 1.03), 95% CI; p=0.09). A trial sequential analysis indicated that the current data are insufficient to reach a definitive conclusion.
conclusionIn summary, despite extensive research on tracheostomy timing and its outcomes, as well as a correlation in our study between early tracheostomy and reduced VAP incidence, evidence remains weak. Besides that, no clear mortality benefits were observed. Further research using a different approach is crucial to identify the specific population that may derive benefits from early tracheostomy.
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