Efetividade da traqueostomia precoce comparada à tardia ou à intubação orotraqueal prolongada nos pacientes com traumatismo cranioencefálico grave: uma revisão sistemática do tipo umbrella

Abstract

Traumatic brain injury (TBI) is a major public health issue worldwide. One of the main concerns in patients with severe TBI is the management of the airway. To determine the effectiveness of early tracheostomy in severe TBI patients, we performed an umbrella review searching in Pubmed, Embase, Scopus, Web of Science, Lilacs, Dare-Cochrane, Open grey and clinical trials. Four meta-analyses were included from 5673 initial records; then, the risk of bias was evaluated, and a new meta-analysis was performed from data obtained in primary studies. The evidence included in this umbrella review suggests that early tracheostomy is effective to reduce ICU (MD -5.69 days [-7.78, -3.59], 95%CI) and Hospital (MD -3.53 days [-4.44, -2.62], 95%CI) length of stay, time in mechanical ventilation (MD -5.08 [-7.12, -3.05], 95%CI) and risk of ventilator associated pneumonia (RR 0.78 [0.70, 0.86], 95%CI). These studies cannot determinate effectiveness of early tracheostomy on mortality (RR 1.32 [0.89, 1.96], 95%CI) and neurological prognosis.