Early Tracheostomy in the Severely Burned Patient: A Systematic Review

Abstract

Introduction: The treatment of patients with extensive burns remains a major challenge in intensive care medicine, requiring specific strategies due to the clinical severity and high risk of complications. Among the possible interventions, early tracheostomy has been discussed as an alternative to optimize ventilatory support in such cases. Objective: To review the published literature on clinical studies of early tracheostomy in severely burned patients, assessing its impact on the duration of mechanical ventilation, incidence of ventilator-associated pneumonia, length of ICU stay and mortality. Methodology: A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was performed in the PubMed, Embase, and Web of Science databases, covering publications from the last 10 years. Data extraction was carried out independently by two reviewers, with disagreements resolved by consensus. The findings were organized and presented in a descriptive and comparative manner to synthesize the available evidence on the clinical impacts of early tracheostomy in burn patients. Results: The initial search yielded 99 articles in PubMed, 30 in Embase, and 329 in Web of Science. After applying the inclusion and exclusion criteria, 11 articles were selected from the databases. To increase the robustness of the sample, the bibliographic references of the included studies were also examined, which allowed the identification and inclusion of five additional articles relevant to the topic, totaling 16 studies selected for the systematic review. Most studies indicated that early tracheostomy is more common in patients with greater clinical severity, but is not associated with increased mortality. Findings regarding the duration of mechanical ventilation are contradictory. Regarding ventilator-associated pneumonia, the results remain inconclusive. The impact on length of stay in the Intensive Care Unit also varied, with some studies suggesting earlier discharge. Conclusion: Early tracheostomy may be safe and potentially beneficial under certain clinical conditions, but its indication should be individualized and based on objective criteria such as burn extent, presence of inhalation injury, and anticipated need for prolonged mechanical ventilation.