Early tracheostomy? Definitely maybe.

Early trachy editorialTracman said no, but others have shown benefit. Siempos’ meta-analysis of 13 trials suggests thinking again. Depending on which statistical model you use, it appears that early tracheostomy may reduce 30 day mortality, particularly, or exclusively in patients with high baseline risk of death. Less pneumonia and, unsurprisingly, shorter ICU stay is also suggested. However longer term mortality is not improved. Difficult to know where this leaves us now. Yet another treatment that might give short term without long term benefit.

It also brings home how fragile much of our knowledge is: different but valid statistical methods give a different ‘truth’.

1 comment

  1. Olusegun Olusanya

    IIRC, this meta-analysis was heavily skewed by TRACMAN…

    Which was heavily skewed by
    A) at least two units not signing up due to lack of equipoise
    B)sedation being left on in a significant number of tracheostomised patients

    Food for thought 🙂

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