Abstract
BACKGROUND: Tracheostomy is an option to ensure airway safety in patients with severe traumatic brain injury. However, the optimal timing for tracheostomy remains unclear based on current evidence. METHODS: Umbrella systematic review to determine the effectiveness of early tracheostomy in TBI. DATABASES: PubMed, Embase, Scopus, Web of Science, Lilacs, Cochrane, Open Grey, and clinical trials. INCLUSION CRITERIA: Meta-analysis of early tracheostomy in severe TBI patients. EXCLUSION CRITERIA: if there was no data regarding the time of death or the follow-up period. DATA EXTRACTION: Selection, risk of bias evaluation, and data extraction were performed by two independent authors. RESULTS: Four meta-analyses were included from 5673 initial records, and a new meta-analysis was performed from data obtained in primary studies. The evidence included in this umbrella review showed that early tracheostomy reduced ICU (MD = -5.69 days; 95% CI [-7.78, -3.59]) and Hospital (MD = -3.53 days; 95% CI [-4.44, -2.62]) length of stay, time in mechanical ventilation (MD = -5.08; 95% CI [-7.12, -3.05]) and risk of ventilator associated pneumonia (RR = 0.78; 95% CI [0.70, 0.86],). These studies cannot determine the effectiveness of early tracheostomy on mortality (RR = 1.32; 95% CI [0.89, 1.96],) or neurological prognosis. CONCLUSIONS: This umbrella review suggests that early tracheostomy is effective in reducing ICU and Hospital length of stay, time in mechanical ventilation, and ventilator-associated pneumonia. INPLASY PROTOCOL: 202280096.