Meta analysis of effect of tracheostomy timing on prognosis of patients with cervical spinal cord injury / 中华创伤杂志

ABSTRACT

Objective To evaluate the effects of early tracheostomy and late tracheostomy on the prognosis of patients with cervical spinal cord injury,so as to provide evidence based guidance for the timing of tracheostomy.Methods Relevant literatures studying the timing of tracheostomy in patients with cervical spinal cord injury were searched in PubMed,Embase,Medline,Cochrane Library,Chinese Biological Medical Literature database (CBM),China National Knowledge Infrastructure database (CNKI),and VIP journal database with time range from journal establishment to March 2018.The retrieved articles were screened according to the inclusion and exclusion criteria.The article quality was rigorously evaluated according to the Newcastle-Ottawa scale (NOS).Meta analysis was conducted using Review Manager 5.3 software to compare the mechanical ventilation time,ICU stay,incidence of pneumonia,incidence of complications,and mortality between early and late tracheostomy in patients with cervical spinal cord injury.Results A total of eight articles of cohort study including 466 patients were included,with 241 patients in the early tracheostomy group and 225 patients in the late tracheostomy group.The eight articles were all determined as high quality studies according NOS.The results of Meta analysis showed that there were significant differences between the two groups in terms of the total mechanical ventilation time (MD =-12.28,95％ CI-20.09--4.47,P ＜ 0.01),post tracheostomy mechanical ventilation time (MD =-9.92,95％ CI-14.27--5.57,P ＜ 0.01),total ICU stay (MD =-10.30,95％ CI-17.12--3.47,P ＜ 0.01),post tracheostomy ICU stay (MD =-5.79,95％ CI -6.53--5.05,P ＜ 0.01),incidence of complications (RR =0.56,95％ CI 0.38-0.83,P ＜ 0.01),and mortality (RR =0.34,95％ CI 0.15-0.78,P ＜ 0.05).However,no significant differences were detected between the two groups in the incidence of total pneumonia (RR =0.77,95％ CI 0.57-1.05,P ＞0.05) and the incidence of post tracheostomy pneumonia (RR =0.80,95％ CI 0.51-1.26,P ＞0.05).Conclusion Early tracheostomy can shorten the mechanical ventilation time,ICU stay,incidence of complications,and mortality,but it cannot reduce the incidence of pneumonia.