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

M e t h o d s Data sources: MEDLINE, CINAHL, EMBASE/Excerpta Medica, Cochrane Central Register of Clinical Trials, National Research Register, the National Health Service Trusts Clinical Trials Register, Medical Research Council U.K. database, National Health Service Research and Development Health Technology Assessment Programme, and British Heart Foundation database (last search in November 2004). Study selection and assessment: Randomized controlled trials (RCTs) or quasi-RCTs that compared early tracheostomy with continued translaryngeal intubation or continued translaryngeal intubation followed by late tracheostomy in critically ill adults requiring artificial ventilation. Early tracheostomy was defined as tracheostomy done ≤ 7 days after admission to the intensive care unit (ICU), initiation of translaryngeal intubation, and mechanical ventilation. Late tracheostomy was any time after early tracheostomy. Outcomes: All-cause mortality. Secondary outcomes included incidence of ventilatorassociated pneumonia (VAP), duration of artificial ventilation, and length of stay in the ICU.