TY - JOUR T1 - Tracheostomy practices in children on mechanical ventilation: a systematic review and meta-analysis1 JO - Jornal de Pediatria (English Edition) T2 - AU - de Araujo,Orlei Ribeiro AU - Azevedo,Rafael Teixeira AU - de Oliveira,Felipe Rezende Caino AU - Colleti Junior,José SN - 00217557 M3 - 10.1016/j.jped.2021.07.004 DO - 10.1016/j.jped.2021.07.004 UR - https://jped.elsevier.es/en-tracheostomy-practices-in-children-on-articulo-S0021755721001170 AB - ObjectiveTo evaluate current practices of tracheostomy in children regarding the ideal timing of tracheostomy placement, complications, indications, mortality, and success in decannulation. Source of dataThe authors searched PubMed, Embase, Cochrane Library, Google Scholar, and complemented by manual search. The guidelines of PRISMA and MOOSE were applied. The quality of the included studies was evaluated with the Newcastle-Ottawa Scale. Information extracted included patients’ characteristics, outcomes, time to tracheostomy, and associated complications. Odds ratios (ORs) with 95% CIs were computed using the Mantel-Haenszel method. Synthesis of dataSixty-six articles were included in the qualitative analysis, and 8 were included in the meta-analysis about timing for tracheostomy placement. The risk ratio for “death in hospital outcome” did not show any benefit from performing a tracheostomy before or after 14 days of mechanical ventilation (p = 0.49). The early tracheostomy before 14 days had a great impact on the days of mechanical ventilation (-26 days in mean difference, p < 0.00001). The authors also found a great reduction in hospital length of stay (-31.4 days, p < 0.008). For the days in PICU, the mean reduction was of 14.7 days (p < 0.007). ConclusionsThe meta-analysis suggests that tracheostomy performed in the first 14 days of ventilation can reduce the time spent on the ventilator, and the length of stay in the hospital, with no effect on mortality. The decision to perform a tracheostomy early or late may be more dependent on the baseline disease than on the time spent on ventilation . ER -