Impact of tracheostomy on ICU stay in adult patients with ARDS: A systematic review

Objective: To investigate the impact of tracheostomy on clinical outcomes in adults with acute respiratory distress syndrome (ARDS) who require mechanical ventilation (MV). Methods: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Three electronic databases including PubMed, The Cochrane Library, and EMBASE to identify relevant studies on ARDS patients receiving MV were searched from inception to July 31, 2024. The reviewers assessed the risk of bias of included studies according to the Cochrane Risk of Bias 1 tool or JBI checklists, as appropriate. Two reviewers independently screened the literature and extracted the data. Outcomes among patients who underwent tracheostomy were compared and analyzed. Results: Twenty studies involving 4,022 patients with ARDS who required tracheostomy were included, comprising 2 randomized controlled trials, 5 prospective studies, 12 retrospective studies, and 1 case series. On average, tracheostomized patients spent 30.2 days in the ICU and 44.8 days in the hospital, with an overall mean duration of MV of 27 days. Tracheostomy-related adverse events were reported in 15 studies and local bleeding was the most common complication. Of the 1,074 patients with tracheostomy, 626 (58.3%) were successfully weaned from the ventilator. Mortality outcomes were documented in 18 studies, indicating that 883 out of 2,302 (38.4%) of these patients died during hospitalization. Conclusion: Tracheostomy in MV patients with ARDS does not have a clearly defined impact on ICU length of stay due to variability in study findings. However, it remains a safe intervention with generally minor complications. Future research should focus on standardized weaning protocols and multidisciplinary rehabilitation strategies to potentially improve patient outcomes. Implications for clinical practice: Tracheostomy allows for a more controlled and gradual weaning process in patients with ARDS requiring prolonged MV. Moreover, although current evidence does not indicate a significant reduction in ICU length of stay, tracheostomy contributes to more effective patient management during the weaning by facilitating oral hygiene, improving mobility, and enabling both verbal communication and oral feeding.