Early tracheostomy in severe traumatic brain injury: an
umbrella systematic review

Raul Ribeiro de Andrade; Edla Vitória Santos Pereira; Igor Hudson Albuquerque e Aguiar; Olavo Barbosa de Oliveira Neto; João Gustavo Rocha Peixoto dos Santos; Fabiano Timbó Barbosa; Célio Fernando de Sousa-Rodrigues

doi:10.1016/j.bjane.2026.844727

Review Article

Early tracheostomy in severe traumatic brain injury: an umbrella systematic review

Traqueostomia precoce em lesão cerebral traumática grave: revisão sistemática em guarda-chuva

Raul Ribeiro de Andrade, Edla Vitória Santos Pereira, Igor Hudson Albuquerque e Aguiar, Olavo Barbosa de Oliveira Neto, João Gustavo Rocha Peixoto dos Santos, Fabiano Timbó Barbosa, Célio Fernando de Sousa-Rodrigues

http://dx.doi.org/10.1016/j.bjane.2026.844727 Braz J Anesthesiol, vol.76, n3, 844727, 2026

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Abstract

Background

Tracheostomy is an option to ensure airway safety in patients with severe traumatic brain injury. However, the optimal timing for tracheostomy remains unclear based on current evidence.

Methods

Umbrella systematic review to determine the effectiveness of early tracheostomy in TBI. Databases: PubMed, Embase, Scopus, Web of Science, Lilacs, Cochrane, Open Grey, and clinical trials. Inclusion criteria: Meta-analysis of early tracheostomy in severe TBI patients. Exclusion criteria: if there was no data regarding the time of death or the follow-up period. Data extraction: Selection, risk of bias evaluation, and data extraction were performed by two independent authors.

Results

Four meta-analyses were included from 5673 initial records, and a new meta-analysis was performed from data obtained in primary studies. The evidence included in this umbrella review showed that early tracheostomy reduced ICU (MD = -5.69 days; 95% CI [-7.78, -3.59]) and Hospital (MD = -3.53 days; 95% CI [-4.44, -2.62]) length of stay, time in mechanical ventilation (MD = -5.08; 95% CI [-7.12, -3.05]) and risk of ventilator associated pneumonia (RR = 0.78; 95% CI [0.70, 0.86],). These studies cannot determine the effectiveness of early tracheostomy on mortality (RR = 1.32; 95% CI [0.89, 1.96],) or neurological prognosis.

Conclusions

This umbrella review suggests that early tracheostomy is effective in reducing ICU and Hospital length of stay, time in mechanical ventilation, and ventilator-associated pneumonia.

Inplasy protocol

202280096.

Keywords

Epidemiology; Length of Stay; Mortality; Tracheostomy; Traumatic brain injury

Resumo

Introdução

A traqueostomia é uma opção para garantir a segurança das vias aéreas em pacientes com lesão cerebral traumática grave. No entanto, o momento ideal para sua realização ainda permanece incerto com base nas evidências atuais.

Métodos

Revisão sistemática em guarda-chuva com o objetivo de determinar a eficácia da traqueostomia precoce em pacientes com TCE grave. Bases de dados: PubMed, Embase, Scopus, Web of Science, Lilacs, Cochrane, Open Grey e registros de ensaios clínicos. Critérios de inclusão: metanálises sobre traqueostomia precoce em pacientes com TCE grave. Critérios de exclusão: ausência de dados sobre tempo de óbito ou período de seguimento. A extração de dados, seleção e avaliação de risco de viés foram realizadas por dois autores independentes.

Resultados

Quatro metanálises foram incluídas a partir de 5.673 registros iniciais, e uma nova metanálise foi realizada a partir de dados de estudos primários. As evidências incluídas nesta revisão em guarda-chuva mostraram que a traqueostomia precoce reduziu o tempo de permanência na UTI (MD = -5,69 dias; IC 95% [-7,78, -3,59]), tempo de internação hospitalar (MD = -3,53 dias; IC 95% [-4,44, -2,62]), tempo de ventilação mecânica (MD = -5,08; IC 95% [-7,12, -3,05]) e risco de pneumonia associada ao ventilador (RR = 0,78; IC 95% [0,70, 0,86]). Esses estudos não conseguiram determinar efeito sobre mortalidade (RR = 1,32; IC 95% [0,89, 1,96]) ou prognóstico neurológico.

Conclusão

Esta revisão em guarda-chuva sugere que a traqueostomia precoce é eficaz na redução do tempo de permanência em UTI e hospital, do tempo de ventilação mecânica e da incidência de pneumonia associada ao ventilador.

Protocolo de Inplasia

202280096.

Palavras-chave

Epidemiologia; Tempo de internação; Mortalidade; Traqueostomia; Lesão cerebral traumática

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Submitted date:
27/07/2025

Accepted date:
22/12/2025