Review: Early tracheostomy is not better than late tracheostomy for reducing all-cause mortality in critically ill patients: COMMENTARY

Sinuff, Tasnim
November 2005
ACP Journal Club;Nov/Dec2005, Vol. 143 Issue 3, p62
Academic Journal
This article comments on a clinical study according to which early tracheostomy is not better than late tracheostomy for reducing all-cause mortality in critically ill patients. Several methodologic limitations of the primary studies in this systematic review may explain the lack of a clear mortality benefit. First, the data came from small, low-quality, primarily single center, RCTs and quasi-RCTs of heterogeneous patient populations. Second, the small total number of patients results in trends for treatment benefit and wide confidence intervals that include harm. In view of the additional heterogeneity of the treatment effect for mortality, VAP, and duration of mechanical ventilation, one may question the rationale for pooling the results of these studies.


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