Banca de QUALIFICAÇÃO: RAUL RIBEIRO DE ANDRADE

Effectiveness of early tracheostomy compared to late or prolonged orotracheal intubation in patients with severe traumatic brain injury: An Umbrella systematic review

head trauma, tracheostomy, mortality

ANDRADE, R.R.. Effectiveness of early tracheostomy compared to late or prolonged orotracheal intubation in patients with severe traumatic brain injury: A systematic review of the Umbrella type. Dissertation (Masters in Health Sciences) – Postgraduate Program in Health Sciences, Institute of Biological and Health Sciences, Federal University of Alagoas, Maceió, 2024. TBI is a global public health problem that largely affects the economically active population. Patients with severe TBI generally require prolonged ventilatory support and undergo tracheostomy. In order to determine the effectiveness of early tracheostomy, we carried out a systematic review of meta-analyses on patients with severe TBI who underwent early tracheostomy, late tracheostomy or maintained in orotracheal intubation, evaluating outcomes such as mortality, complications and improvement in quality of life. We used the Pubmed, Lilacs, Embase, Scopus, Web of Science, Central and Sigle databases, and the Robis tool to analyze the risk of bias. Among the 5673 records identified, we selected four meta-analyses and from these we evaluated data from primary studies showing a significant reduction in mechanical ventilation times (MD -5.08 [-7.12, -3.05]), hospitalization in bed intensive care (MD -5.69 [-7.78, -3.59]) and in a hospital bed (MD -3.53 [-4.44, -2.62]), in addition to a possible benefit in reduced risk of pneumonia associated with mechanical ventilation (RR 0.78 [0.70, 0.86]) in patients undergoing early tracheostomy. There was no difference between the groups in terms of mortality (RR 1.86 [0.90, 3.84]), however, this result was based on a low level of evidence. Therefore, early tracheostomy appears to bring benefits to patients with severe TBI, mainly related to the time spent in hospital care.